title: Combining carotid endarterectomy with off-pump coronary artery bypass graft surgery is safe and effective.
abstract: BACKGROUND
  We, as neurologists, are frequently consulted to give neurological clearance for surgery in patients who are undergoing coronary artery bypass graft (CABG) surgery and have suffered from stroke or transient ischemic attack (TIA) in past. Similarly clearance is also sought in another group of patients who, though have not suffered from stroke or TIA, but found to have significant carotid stenosis on routine screening prior to surgery. Cardiac surgeons and anesthetists want to know the risk of perioperative stroke in such patients and should carotid endarterectomy (CEA) be done along with CABG. In absence of any clear-cut guideline, neurologists often fail to give any specific recommendation.
  
  
  OBJECTIVE
  To find out safety and efficacy of synchronous CEA in patients undergoing CABG.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Out of 3,700 patients who underwent CABG, 150 were found to have severe carotid stenosis of >70%. Out of this, 46 patients with >80% stenosis (three symptomatic and 43 asymptomatic) and one patient with >70% symptomatic carotid stenosis (TIA within last 2 weeks) were taken for simultaneous CEA along with CABG. These three symptomatic carotid patients had suffered from stroke within last 6 months.
  
  
  RESULTS
  One patient with asymptomatic near total occlusion of carotid artery suffered from hyperperfusion syndrome. None suffered from ischemic stroke, myocardial infarction (MI), or death during perioperative period.
  
  
  CONCLUSIONS
  Combining CEA along with CABG is a safe and effective procedure.
authors.affiliation: Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Garg
authors.affiliation: Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Atma Ram
authors.initials: AR
authors.lastname: Bansal
authors.affiliation: Institute of Neuroscience, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Dilip
authors.initials: D
authors.lastname: Singh
authors.affiliation: Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Manisha
authors.initials: M
authors.lastname: Mishra
authors.affiliation: Department of Clinical Research, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Pooja
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Medanta Heart Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Ravi Ratan
authors.initials: RR
authors.lastname: Kasliwal
authors.affiliation: Medanta Heart Institute, Medanta The Medicity, Gurgaon, Haryana, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Trehan
keywords: Carotid endarterectomy; coronary artery bypass graft surgery; off-pump CABG; peri-operative stroke