A first-round draft pick of Toronto in 1990, Karsay was traded to Oakland in the July 1993 deal that sent Rickey Henderson to the Blue Jays. The right-hander showed promise as a starter when the A’s called him up to the majors in August 1993, but his career took a drastic turn when two separate elbow operations, including “Tommy John” surgery in June 1995, forced him to miss two full seasons. When he made it back to the majors in 1997, Karsay was hammered in 24 starts (3-12, 5.77 ERA) for Oakland. Dealt to the Indians that December, he revived his career as a short reliever, where his mid-90s fastball and sharp-breaking curve proved a formidable combination.
In 50 appearances, all but three from the bullpen, Karsay won 10 games with a 2.97 ERA in 1999. He notched 20 saves in 29 chances the next year, serving as Cleveland’s primary closer until the club added Bob Wickman in a July 2000 trade. The following June Karsay was sent to the Braves along with fellow reliever Steve Reed for lefty John Rocker. Over 74 games with the Braves and Indians in 2001 he collected three wins and eight saves while posting a 2.35 ERA, allowing just 73 hits in 88 innings.