Assessment of Carotid Artery Stenosis and Lower Limb Peripheral Ischemia Prior to CABG

Inclusion Criteria: 1. The acceptance of the patients to participate in the study in the form of a written consent. 2. Patients of both sexes. 3. Three vessels disease for CABG. 4. Patients' age: from 35 to 75 years old. 5. Elective, isolated, primary cases of CABG. 6. Patients with ejection fraction above 40%. 7. Inclusion criteria for the high-risk group will include: 1. Patients with preoperative history of cerebrovascular events or symptoms suggestive of CVS eg.TIA, transient blindness in one eye, Dizziness, Confusion, Drowsiness, Headache, Temporary inability to speak or move. 2. Carotid bruit 3. Left main stem coronary artery disease 4. Presence of other peripheral vascular disease Exclusion Criteria: 1. Patients refusing to participate in the study. 2. Age 76 years or above 3. Morbid obese patients (body mass index more than 35). 4. Patients who underwent coronary stenting before. 5. Patients who underwent previous cardiac operation before. 6. Patients with impaired renal functions (serum creatinine \> 1.5 mg/dl, blood urea \> 100 mg/dl and K+ \> 5 meq/L). 7. Patients with preoperative hemoglobin \< 9 gm/dl, white blood cells \> 15,000 cells/mcl,platelets count \< 140,000 per microliter. 8. Patients with rhythm defects by electrocardiography (ECG). 9. Patients with preoperative O2 saturation \< 90 % by pulse oximetry.