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Asymptomatic Carotid Stenosis Before CABG — FRCA Final MCQ

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HardCardiothoracic AnaesthesiaAsymptomatic Carotid Stenosis Before CABGFRCA Final

A 55-year-old man undergoes coronary angiography which shows three-vessel disease. He is referred for CABG. Preoperatively he is found to have a carotid bruit. Duplex ultrasound shows a 75% stenosis of the left internal carotid artery. He is asymptomatic from the carotid disease. What is the recommended management?

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Correct answer: B — Proceed with CABG without carotid intervention

For asymptomatic carotid stenosis discovered incidentally before cardiac surgery, current evidence (including the NICE stroke guidelines and ESC cardiac surgery guidelines) suggests that the risk of stroke from carotid disease during CABG is lower than the combined risk of staged or simultaneous procedures. There is no evidence that prophylactic carotid intervention reduces perioperative stroke risk in asymptomatic patients undergoing CABG. The majority of perioperative strokes during CABG are embolic from the ascending aorta, not from carotid disease.

Reference: NICE – 2019 – NG128 Stroke and TIA; ESC – 2024 – Cardiac surgery guidelines; RCOA – 2023 – Cardiothoracic module