Bilateral carotid stenting prior to coronary artery bypass graft: a case report.
BACKGROUND
Carotid stenosis is an independent possible complication of the central nervous system of patients after receiving a coronary artery bypass graft (CABG). The risk increases when the patient has bilateral carotid stenosis even if asymptomatic.


METHODS
A 76 year-old female was admitted because of unstable angina. The coronary angiography showed triple vessel disease and required CABG for revascularization. Her physical examination revealed bilateral carotid bruits. She did not have any history of neurological deficit. Carotid Doppler showed critical stenosis of bilateral carotid arteries. The carotid angiography demonstrated 70 per cent diameter stenosis of both internal carotid arteries just above the bifurcation of the external carotid artery. A 7 x 20 mm self-expandable Smart stent was implanted first in the right carotid artery with good angiographic result. Five days later, another 7 x 20 mm self-expandable Smart stent was implanted in the left carotid artery without residual stenosis. The patient did not have any cardiovascular complications. CABG was performed 2 weeks later with a good result. The patient was discharged 10 days after CABG.


CONCLUSIONS
Bilateral carotid stenting is feasible and produces an acceptable outcome. This procedure is an alternative treatment for preventing stroke during CABG surgery.
Srimahachota
Suphot
S
Cardiac Center and Division of Cardiology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Singhatanadgige
Seri
S
Boonyaratavej
Smonporn
S
Chayanont
Duanchai
D
D000368:Aged; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D002404:Catheterization / Q000295:instrumentation* / Q000379:methods; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018570:Risk Assessment; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome