Silent Coronary Artery Disease in Symptomatic Candidates for Carotid Revascularization Intervention
Jae Guk Kim1, Soo Joo Lee, Hanna Choi
1Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea.
Insights
Approximately 60% of stroke patients with carotid artery stenosis (CAS) also have coronary artery disease (CAD). Hypertension and high cholesterol are associated with this silent CAD, highlighting risks for revascularization candidates.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Concurrent coronary artery disease (CAD) and carotid artery stenosis (CAS) are common in patients needing revascularization.
- Asymptomatic CAD poses significant prognostic implications in patients with symptomatic CAS.
Purpose of the Study:
- To determine the frequency of asymptomatic CAD in stroke patients with CAS.
- To identify factors associated with asymptomatic CAD in this patient group.
Main Methods:
- Coronary angiography performed post-cerebral angiography in 96 patients with symptomatic CAS.
- Patients were candidates for revascularization.
Main Results:
- Significant CAD (stenosis ≥50%) found in 60.4% of patients.
- Hypertension (OR 3.86), high non-HDL cholesterol (OR 3.20), and intracranial atherosclerosis (OR 4.39) were associated with silent CAD.
Conclusions:
- Over 60% of stroke patients with extracranial CAS have concurrent CAD.
- Hypertension, hyperlipidemia, and intracranial atherosclerosis increase the risk of asymptomatic CAD in patients undergoing carotid revascularization.
Background:
Concurrent coronary artery disease (CAD) and carotid artery stenosis (CAS) are frequently detected in clinical practice and have important prognostic implications in symptomatic patients who are considered for revascularization. The aim of this study was to assess the frequency of asymptomatic CAD in stroke patients with CAS and the associated factors.
Methods:
Coronary angiography was performed at a single session after cerebral angiography in patients with symptomatic CAS, which was considered a candidate for revascularization.
Results:
Ninety-six patients were enrolled. We detected significant (defined as a degree of stenosis ≥50%) atherosclerotic coronary lesions in 58 patients (60.4%). Of these 58 patients, 32 (55.2%) had one-vessel, 19 (32.7%) 2-vessel, and 7 (12.1%) 3-vessel disease. Potential factors associated with the silent CAD were hypertension (OR 3.86, p = 0.022), a high level (≥140 mg/dl) of non-high-density lipoprotein cholesterol (OR 3.20, p = 0.041), and combined intracranial atherosclerosis steno-occlusion on cerebral angiogram (OR 4.39, p = 0.015).
Conclusions:
About 60% of stroke patients with extracranial CAS have an incident CAD. Hypertension, hyperlipidemia, and the atherosclerotic changes of combined extracranial carotid and intracranial arteries may increase the risk of asymptomatic CAD in symptomatic candidates for carotid revascularization intervention.
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