Management of severe bilateral carotid artery stenosis concomitant to severely symptomatic coronary arterial disease requiring coronary artery bypass grafting: a case-based review

Patients with significant carotid disease have an increased risk of stroke during coronary artery bypass grafting (CABG). However, due to its inherent risk and to the variety of mechanisms responsible for postoperative stroke, prophylactic carotid endarterectomy has an uncertain value, particularly in cases of asymptomatic unilateral carotid disease. In addition, the timing and sequence of coronary and carotid surgeries are controversial matters. Prophylactic carotid artery stenting is emerging as a potentially safer strategy. The major limitation of carotid stenting is the need for one month of dual antiplatelet therapy and the potential need to postpone CABG, which is not possible in patients with refractory unstable coronary syndromes. We describe the case of a patient with severe unstable coronary artery disease and bilateral carotid artery disease who was successfully managed with stenting of the most critical coronary lesion, staged bilateral carotid stenting, followed by CABG three weeks later.