Prevalence of extracranial carotid artery disease in symptomatic peripheral artery disease and implications for long-term outcome.

BACKGROUND

Patients with peripheral artery disease (PAD) still experience excessive rates of fatal cardiovascular events. In this context, the relevance of co-existing extracranial carotid artery disease (ECAD) on outcome in patients with PAD is unclear. Thus, this study elucidates long-term outcome effects of the presence of both atherosclerotic entities for further risk stratification.

MATERIALS AND

METHODS

A total of 669 patients from the Lip-LEAD study with symptomatic PAD (Fontaine stage 2-4) were evaluated for ECAD (internal carotid artery stenosis >50%) with ultrasonography within 6 months after endovascular repair for PAD. Outcome was assessed with a long-term follow-up period with a maximum of 10 years.

RESULTS

Patients presenting with ECAD (n = 245, 36.7%) exhibited worse hemodynamic parameters of PAD than those without (ankle-brachial index (ABI). (0.53 (0.37-0.68) vs. 0.57 (0.47-0.68), p = 0.009; toe-brachial index (TBI) (0.50 (0.36-0.63) vs. 0.55 (0.42-0.70), p = 0.005). Significant correlations between grade of carotid stenosis and ABI as well as TBI were present (r=-0.190, p < 0.001; r=-0.219, p < 0.001). Cox-regression analyses revealed worse outcome in patients with ECAD for both all-cause and cardiovascular (CV)-mortality after multivariable adjustment for traditional CV risk-factors [1.48 (2.02-2.17); 2.10 (1.19-3.69)].

CONCLUSION

Patients with additional ECAD to symptomatic PAD exhibited an unfavourable long-term outcome in comparison to those without. The results suggest that the additional presence of ECAD highlights a highly vulnerable cohort of patients with symptomatic PAD at risk for further fatal CV events and thus should be considered for further diagnostic evaluation and stronger risk modification initiatives.