Asymptomatic Carotid Stenosis in Cardiac Surgery Patients

See related article, p 2769 stenosis is a known risk factor for stroke after heart surgery1; yet, outcome of surgeries combining carotid endarterectomy (CEA) with coronary artery bypass graft (CABG) is worse than after CABG alone.2 It is not clear, however, whether this difference in outcomes is because of inherent differences in those people needing combined surgeries, who likely have more extensive vascular disease, as compared with individuals only requiring isolated CABG procedures. As a result of these differences in outcomes, other management options have been considered: previous studies have evaluated combined CEA or carotid stenting with CABG surgery, or staged surgeries, with some findings suggesting that stenting might be preferred in this population3 and that staged procedures might do better than combined procedures,4 but other studies failing to find a difference in outcome based on staged versus synchronous procedures.5 To date, no large clinical trial had directly compared therapy options head-to-head, which is why the safety of simultaneous CABG and carotid endarterectomy versus isolated CABG (CABACS [Coronary Artery Bypass graft surgery in patients with Asymptomatic Carotid Stenosis]) trial by Weimar et al,6 published in this issue of Stroke , is …