Concomitant coronary and asymptomatic carotid artery disease in patients prior to myocardial revascularization
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J Mand'ák1, V Lonský, J Dominik
1Department of Cardiac Surgery, University Hospital, Charles University Faculty of Medicine.
Insights
A significant number of ischemic heart disease patients have carotid artery atherosclerosis. Early detection and management of carotid artery disease are crucial for preventing stroke in these patients.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Diagnostic Imaging
Background:
- Ischemic heart disease (IHD) patients often present with concurrent cerebrovascular disease.
- Carotid artery atherosclerosis is a significant risk factor for stroke in patients with IHD.
Purpose of the Study:
- To evaluate the prevalence and severity of carotid artery atherosclerosis in patients undergoing myocardial revascularization.
- To determine the optimal timing and approach for managing carotid artery disease in this patient cohort.
Main Methods:
- Ultrasound examinations of the carotid arteries were performed in 525 patients with IHD prior to myocardial revascularization.
- Patients were categorized based on the presence and severity of carotid artery sclerotic changes and stenoses.
- Age-related differences in atherosclerosis prevalence were analyzed.
Main Results:
- Over half (59.4%) of patients exhibited asymptomatic carotid artery sclerotic changes.
- Hemodynamically significant stenoses (>50%) were found in 12.2% of patients.
- Critical stenoses (>85%) or occlusions were identified in 3.6% of patients, with higher prevalence in older patients (>65 years).
Conclusions:
- Carotid artery ultrasound screening is essential for patients with IHD undergoing revascularization.
- Myocardial revascularization is preferably performed before carotid artery surgery, except in specific complex cases.
- Management strategies should consider the severity of carotid stenosis and patient age.
Abstract:
The authors report on the results of ultrasound examinations of the carotid arteries in 525 patients with ischemic heart disease, hospitalized at the Department of Cardiac Surgery in Hradec Králové, prior to myocardial revascularization. Only 213 patients (40.6%) had intact carotid bed. The remaining 312 patients (59.4%) were found to have asymptomatic sclerotic changes of varying degrees of severity. Haemodynamically significant stenoses of over 50% were found in 64 cases (12.2%). 19 patients (3.6%) had critical stenoses of over 85% or occlusions of one or both internal carotid arteries. Comparison between patients younger than 65 and older than 65 showed significant increase of sclerotic changes in the older group. The authors prefer to perform myocardial revascularization procedure in hypothermic CPB with alpha-stat regime before carotid artery surgery. Combined procedures are preferred only in cases with concomitant neurologic and coronary symptomatology or in cases with severe carotid stenoses or occlusions of both arteries.