Silent Coronary Artery Disease in Symptomatic Candidates for Carotid Revascularization Intervention.

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.