Patients with bilateral high degree carotid stenosis or occlusion impose high risk for neurological complications during coronary arterial bypass surgery (CABG). Former articles have described successful CABG in patients with bilateral carotid artery occlusion with uneventful recovery, with perioperative cerebral blood flow (CBF) monitoring consisting of EEG or near-infrared spectroscopy (NIRS). In this case report we describe use of pulsatile flow on cardiopulmonary bypass (CPB) and transcranial doppler (TCD) monitoring during a successful CABG in a patient with bilateral carotid occlusion, which led to a safe approach where changes in CBF were seen and analyzed with no lag between event and monitoring.

Patients with previous CVA/TIA in the presence of carotid disease requiring coronary arterial bypass surgery (CABG) are associated with a higher risk of neurological ischemic event.