Evaluation of coexistent carotid and coronary disease by combined angiography

We studied 247 patients who underwent combined coronary and carotid angiography to determine (a) the frequency of angiographic carotid stenosis (> 50%) in patients with coronary artery disease (CAD) and (b) the technical quality and safety of the combined procedure. All patients were evaluated primarily for CAD. Combined carotid angiography was performed for asymptomatic carotid bruits (115 patients, 47%), transient ischemic attacks (TIA) or stroke (66 patients, 26.5%), or inapparent/other reasons (66 patients, 26.5%). The extracranial internal carotid arteries were well visualized in 219 patients (89%); poor visualization of the internal carotid arteries was due to overlap by the vertebral or external carotid arteries. The frequency of >50% internal carotid stenosis was 36% in patients with asymptomatic carotid bruits, 42% in patients with TIA or stroke, and 8% in patients without TIA, stroke, or carotid bruits. Complication rates during combined coronary and carotid angiography in the 247 study patients were not statistically different from complication rates during coronary angiography alone in 686 control patients. These data indicate that (a) patients with CAD who have asymptomatic carotid bruits or a history of TIA or stroke have a high frequency of carotid stenosis, and (b) combined coronary and carotid angiography is a safe and technically adequate procedure.