The preoperative care includes assessment for coronary heart disease. In one study, 40% of patients had coronary heart disease, with 18% of the patients (or 48% of those with coronary heart disease) had severe disease (obstruction of the left main or three of the arteries). The strongest predictor of coronary heart disease was the presence of diabetes mellitus. The presence of bilateral carotid disease was not a significant prediction of coronary disease. The presence of cardiac symptoms probably increasess the likelihood of coronary disease.
The role of coronary angiography and myocardial revascularization are not established. A cohort study suggests that myocardial revascularization should be done first as a separate procedure.
Adverse effects are less common when endarterectomy is performed by an experienced surgeon.
Carotid endarterectomy may both causeand improve orthostatic hypotension and "vasodepressor-type carotid sinus syndrome caused by compression of the carotid baroreceptors by atherosclerotic plaques."
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