[Evaluation of carotid intima-media thickness in patients with severe aortic stenosis. Thrombosis group study in eastern Brittany]

Coronary angiography is a recommended investigation in the preoperative assessment of aortic valve replacement for aortic stenosis in the absence of a reliable non-invasive diagnostic method. Ultrasonographic quantification of carotid artery intima-media thickness, being correlated to the severity of coronary atherosclerosis, could therefore be useful in the screening of coronary artery disease in severe aortic stenosis. The authors studied a group of 100 patients (69.5 +/- 8.5 years: 64 men) with severe aortic stenosis. A control group of 45 patients with coronary artery disease without valvular disease (69.5 +/- 6 years: 30 men) was used for reference. Significant coronary artery disease was found in 21 of the 100 study cases. The average intima-media thickness was 0.608 +/- 0.090 mm. There was no significant difference in intima-media thickness between the coronary and non-coronary patients of the study group (0.612 +/- 0.094 mm and 0.607 +/- 0.094 mm respectively). It was, however, significantly greater in the control group patients compared with the 21 coronary patients in the study group (0.699 +/- 0.082 mm and 0.612 +/- 0.094 mm; p = 0.0004). Finally, 71.1% of patients in the control group had atheromatous carotid artery plaques compared with 59% in the study group (p = 0.005). The measurement of carotid intima-media thickness does not allow detection of coronary patients in severe aortic stenosis. The finding of a lower intima-media thickness in this population compared with coronary patients without valvular disease suggests that aortic stenosis may have a protective effect on the wall thickness of carotid arteries.