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Internal carotid artery stenosis in patients with degenerative aortic stenosis

Anna Kabłak-Ziembicka1, Tadeusz Przewłocki, Marta Hlawaty

  • 1Department of Cardiac and Vascular Diseases, Institute of Cardiology, Collegium Medicum, Jagiellonian University, The John Paul II Hospital, Krakow, Poland.

Kardiologia Polska
|September 23, 2008
PubMed

Insights

Internal carotid artery stenosis (ICAS) affects 13% of severe degenerative aortic stenosis (DAS) patients, rising to 27% with coronary artery disease (CAD). CAD, diabetes, and smoking are key risk factors.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Surgery
  • Interventional Cardiology

Background:

  • Severe degenerative aortic stenosis (DAS) poses a significant surgical risk, especially when combined with coronary artery disease (CAD) and internal carotid artery stenosis (ICAS).
  • Operative mortality for isolated aortic valve replacement (AVR) is 3%, but increases substantially with co-existing CAD and ICAS.

Purpose of the Study:

  • To determine the prevalence of internal carotid artery stenosis (ICAS) greater than or equal to 50% in patients with severe calcified DAS undergoing AVR.
  • To identify factors associated with the occurrence of ICAS in this patient population.

Main Methods:

  • 104 patients with symptomatic moderate-to-severe DAS underwent coronary angiography and Doppler ultrasound of carotid arteries prior to AVR.
  • Lumen stenosis in carotid arteries was assessed using Doppler ultrasound.

Main Results:

  • Significant CAD (>=50% stenosis) was present in 42.3% of patients, and ICAS (>=50% stenosis) was found in 12.5% of patients.
  • ICAS prevalence was significantly higher in patients with CAD (27.3%) compared to those without CAD (1.7%) (p <0.001).
  • Independent predictors for ICAS included concomitant CAD, diabetes, cigarette smoking, and reduced left ventricular ejection fraction.

Conclusions:

  • Internal carotid artery stenosis (ICAS) greater than or equal to 50% affects 13% of patients with isolated DAS and 27% of those with concomitant CAD.
  • Coronary artery disease (CAD), diabetes, and cigarette smoking are independent risk factors for ICAS.
  • Duplex ultrasound of carotid arteries is recommended for patients with DAS and concurrent CAD before AVR.
Abstract

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