, hyper- tension, smoking, and diabetes mellitus).858,859 (Level of Evidence: C) Hillis et al 2011 ACCF/AHA CABG Guideline e687 2. In the CABG patient with a previous TIA or stroke and a significant (50% to 99%) carotid artery stenosis, it is reasonable to consider carotid revascu- larization in conjunction with CABG. In such an individual, the sequence and timing (simultaneous or staged) of carotid intervention and CABG should be determined by the patient s relative magnitudes of cerebral and myocardial dysfunction. (Level of Evi- dence: C) Class IIb 1. In the patient scheduled to undergo CABG who has no history of TIA or stroke, carotid revasculariza- tion may be considered in the presence of bilateral severe (70% to 99%) carotid stenoses or a unilateral severe carotid stenosis with a contralateral occlu- sion. (Level of Evidence: C) Because the presence of extracranial disease of the internal carotid artery is a risk factor for adverse neurological events after CABG,860 one might argue for use of carotid noninva- sive scanning (duplex ultrasonography or noninvasive carotid screening) in all patients scheduled for CABG. At issue is the effectiveness of noninvasive carotid screening in identifying carotid artery stenoses of hemodynamic significance. Alter- natively, the identification of preoperative risk factors known to be associated with the presence of carotid artery disease could be used to stratify patients into high- and low-risk categories, thereby allowing for a more selective use of noninvasive carotid screening. A retrospective analysis of 1421 consecutive CABG patients identified the following as risk factors for significant carotid artery disease: age 65 years, presence of a carotid bruit, and a history of cerebro- vascular disease.858 In so doing, they reduced preoperative testing by 40%, with only a negligible impact on surgical management or neurological outcomes. 