Objective: Cerebrovascular atherosclerosis is known to play a crucial role in perioperative stroke in coronary arterial bypass grafting (CABG). This study is to identify the degree of severity of cerebrovascular lesions for which patients can still undergo CABG with an acceptably low risk in current techniques. Methods: Cerebrovascular atherosclerosis was evaluated and graded for 200 consecutive patients prior to CABG. Grading was initially based on the level of stenosis in carotid, vertebral, and cerebral arteries: grade-0: normal or mild stenosis in cerebral arteries or stenosis <50% in other arteries; grade-1: moderate in cerebral arteries or 50% - 69% in others; grade-2: severe in cerebral arteries or 70% - 89% in others; grade-3: occlusion in cerebral arteries or 90% - 100% in others. The grading was finally adjusted to a risk of regional ischemia by considering symptoms, number of lesions, and brain perfusion in scintigram. Therefore, some patients were up-graded. Off-pump CABG was scheduled for all patients. The lowest systolic arterial pressure during surgery was differently controlled in each grade: grade-0: ≥70 mmHg; grade-1: ≥80 mmHg; grade-2: ≥80 mmHg with intra-aortic balloon pump (IABP); grade-3: ≥90 mmHg with IABP; grade-4: ≥90 mmHg with IABP and administration of thyamiral. Results: Grade-1 and -2 included 38 and 29 patients respectively. Grade-3 initially included 36 patients and 14 of them were up-graded to grade-4 (extremely high risk patients). Stroke was seen in one patient (0.5%), for whom mild speaking disturbance occurred on the fifth day from CABG. Conclusion: Patients with severe cerebrovascular atherosclerosis can undergo CABG with a low risk of stroke. Intraoperative management of blood pressure may be critical for stroke prevention in CABG.
 G. W. Roach, M. Kanchuger, C. M. Mangano, M. Newman, N. Nussmeier, R. Wolman, et al., “Adverse Cerebral Outcomes after Coronary Artery Bypass Surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators,” The New England Journal of Medicine, Vol. 335, No. 25, 1996, pp. 1857-1863. http://dx.doi.org/ 10.1056/NEJM199612193352501
 A. R. Naylor, Z. Mehta, P. M. Rothwell and P. R. F. Bell, “Carotid Artery Disease and Stroke during Coronary Artery Bypass: A Critical Review of the Literature,” European Journal of Vascular and Endovascular Surgery, Vol. 23, No. 4, 2002, pp. 283-294. http://dx.doi.org/10.1053/ejvs.2002.1609
 A. R. Naylor, R. L. Cuffe, P. M. Rothwell and P. R. F. Bell, “A Systematic Review of Outcomes Following Staged and Synchronous Carotid Endarterectomy and Coronary Artery Bypass,” European Journal of Vascular and Endovascular Surgery, Vol. 25, No. 5, 2003, pp. 380-389. http://dx.doi.org/10. 1053/ejvs.2002.1895
 S. Manabe, T. Shimokawa, T. Fukui, K. Fumimoto, N. Ozawa, H. Seki, et al., “Influence of Carotid Artery Stenosis on Stroke in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting,” European Journal of Vascular and Endovascular Surgery, Vol. 34, No. 5, 2008, pp. 1005-1008. http://dx.doi.org/10.1016/j.ejcts.2008.08.005
 S. Venkatachalam, B. H. Gray, D. Mukherjee and M. H. Shishehbor, “Contemporary Management of Concomitant Carotid and Coronary Artery Disease,” Heart, Vol. 97, No. 3, 2011, pp. 175-180. http://dx.doi.org/10.1136/hrt.2010.203612
 A. R. Naylor, “Does the Risk of Post-CABG Stroke Merit Staged or Synchronous Reconstruction in Patients with Symptomatic or Asymptomatic Carotid Disease?” The Journal of Cardiovascular Surgery, Vol. 50, No. 1, 2009, pp. 71-81.
 P. Kolh, W. Wijns, N. Danchin, C. D. Mario, V. Falk, T. Folliguet, et al., “Guidelines on Myocardial Revascularization. The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESAC) and the European Association of the Cardio-Thoracic Surgery (EACTS),” European Journal Cardio-Thoracic Surgery, Vol. 38, 2010, pp. S1-S52. http://dx.doi.org/10.1016/j.ejcts. 2010.08.019
 E. J. Lee, K. H. Choi, J. S. Ryu, S. B. Jeon, S. W. Lee, S. W. Park, et al., “Stroke Risk after Coronary Artery Bypass Graft Surgery and Extent of Cerebral Artery Atherosclerosis,” Journal of the American College of Cardiology, Vol. 57, No. 18, 2011, pp. 1811-1818. http://dx.doi.org/10.1016/j.jacc. 2010.12.026
 S. Ohuchi, K. Kawazoe, H. Izumoto and K. Yoshioka, “Head and Neck Magnetic Resonance Angiography before Coronary Artery Bypass Grafting,” Surgery Today, Vol. 35, No. 6, 2005, pp. 432-435. http://dx.doi.org/10.1007/s00595-004-2973-4
 K. Uekita, N. Hasebe, N. Funayama, H. Aoyama, K. Kuroda, H. Aizawa, et al., “Cervical and Intracranial Atherosclerosis and Silent Brain Infarction in Japanese Patients with Coronary Artery Disease,” Cerebrovascular Diseases, Vol. 16, No. 1, 2003, pp. 61-68. http://dx.doi.org/10.1159/ 000070117
 P. Y. Etienne, S. Papadatos, D. Glineur, Y. Mairy, E. E. Khoury, P. Noirhomme, et al., “Reduced Mortality in High-Risk Coronary Patients Operated off Pump with Preoperative Intraaortic Balloon Counterpulsation,” The Annals of Thoracic Surgery, Vol. 84, No. 2, 2007, pp. 498-503.
 T. Wannarong, G. Parraga, D. Buchanan, A. Fenster, A. A. House, D. G. Hackam, et al., “Progression of Carotid Plaque Volume Predicts Cardiovascular Events,” Stroke, Vol. 44, No. 7, 2013, pp. 1859-1865. http://dx.doi.org/10.1161/STROKEAHA.113.001461
 A. Ito, T. Goto, K. Maekawa, T. Baba, Y. Mishima and K. Ushijima, “Postoperative Neurological Complications and Risk Factors for Pre-Existing Silent Brain Infarction in Elderly Patients Undergoing Coronary Artery Bypass Grafting,” Journal of Anesthesia, Vol. 26, No. 3, 2012, pp. 405-411. http://dx.doi.org/10.1007/s00540-012-1327-4
 R. Pawlaczyk, D. Swietlik, R. Lango and J. Rogowski, “Off-Pump Coronary Surgery May Reduce Stroke, Respiratory Failure, and Mortality in Octogenarians,” The Annals of Thoracic Surgery, Vol. 94, No. 1, 2012, pp. 29-37. http://dx.doi.org/10.1016/j.athoracsur.2012.03.037
 K. Nakanishi, S. Takeda, C. Kim, S. Kohda and A. Sakamoto, “Postoperative Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting or Cardiac Valve Surgery: Intraoperative Use of Landiolol,” Journal of Cardiothoracic Surgery, Vol. 8, No. 1, 2013, pp. 19-25. http://dx.doi.org/ 10.1186/1749-8090-8-19
 R. Z. Zhan, N. Fujiwara, T. Yamakura, K. Taga, S. Fukuda and K. Shimoji, “Differential Inhibitory Effects of Thiopental, Thiamylal and Phenobarbital on Both Voltage-Gated Calcium Channels and NMDA Receptors in Rat Hoppocampal Slices,” British Journal of Anaesthesia, Vol. 81, No. 6, 1998, pp. 932-939. http://dx.doi.org/10.1093/bja/81.6.932
 I. Yoshioka, M. Sakurai, A. Namai and T. Kawamura, “Postoperative Treatment of Carvedilol Following Low Dose Landiolol Has Preventive Effect for Atrial Fibrillation after Coronary Artery Bypass Grafting,” The Thoracic and Cardiovascular Surgeon, Vol. 57, No. 8, 2009, pp. 464-467. http://dx.doi.org/ 10.1055/s-0029-1186069
 S. Moritz, J. Rochon, S. V?lkel, M. Hilker, J. Hobbhahn, B. M. Graf, et al., “Determinants of Cerebral Oximetry in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting: An Observational Study,” European Journal of Anaesthesiology, Vol. 27, No. 6, 2010, pp. 542-549.
 B. Atasever, C. Boer, R. Speekenbrink, J. Seyffert, P. Goedhart, B. D. Mol, et al., “Cardiac Displacement during Off-Pump Coronary Artery Bypass Grafting Surgery: effect on Sublingual Microcirculation and Cerebral Oxygenation,” Interactive Cardiovascular and Thoracic Surgery, Vol. 13, No. 6, 2011, pp. 573-578. http://dx.doi.org/10.1510/icvts.2011.272047
 P. K. Smith, “Predicting and Preventing Adverse Neurologic Outcomes with Cardiac Surgery,” Journal of Cardiac Surgery, Vol. 21, No. Suppl 1, 2006, pp. S15-S19. http://dx.doi.org/10.1111/j.1540-8191. 2006.00215.x