Letter by Weimar and Knipp Regarding Article, “Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery”

Abstract

To the Editor: We read with great interest the article by Mahmoudi et al.1 In this retrospective analysis of 878 consecutive patients undergoing coronary artery bypass graft (CABG) surgery, the authors found similar perioperative stroke rates and mortality in 117 patients with ≥75% asymptomatic carotid artery stenosis (CAS) compared with 761 patients without severe CAS. The authors conclude that these results argue against routine synchronous carotid intervention in patients with asymptomatic severe CAS undergoing CABG but that such an approach is indicated in a selected cohort of patients, such as those with the most severe disease in association with unstable cardiac symptoms and/or significant comorbidities. Another retrospective study identified a higher risk of stroke during isolated CABG only in those patients with an impaired cerebral autoregulation distal to severe …