Coexistence of Internal Carotid Artery Stenosis in Patients with Abdominal Aortic Aneurysm

Abstract

Background and ObjectivesAbdominal Aortic Aneurysm (AAA) and carotid disease have medical and social significance, considering their morbidity, disability, and economic consequences. The study objectives were to determine the prevalence of asymptomatic internal carotid artery (ICA) lesions ≥70% in patients with AAA, the correlation of AAA diameter with the degree of ICA stenosis and symptoms, and the importance of preventive ultrasound checkups.Subjects and MethodsA prospective non-randomized controlled study including 740 patients, aged from 18-85 years, who were suitable for the inclusion and exclusion criteria and reported at the vascular laboratory of the Institute for Vascular and Endovascular Surgery, Clinical Center of Serbia from 1st of December 2011 to the 1st of November 2012.ResultsThe prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is 10.8%. Male representatives have more symptomatic ICA stenosis ≥70%. Patients with small aneurysms more often have asymptomatic ICA stenosis ≥70%. The occurrence of symptoms of carotid disease was more prevalent among patients with ICA stenosis ≥70% compared to the group with stenosis <70%. There was no correlation found between the grade of ICA stenosis with the size of AAA.ConclusionThe prevalence of asymptomatic ICA stenosis ≥70% in patients with AAA is found to be 10.8%. Male patients with ICA stenosis ≥70% more often had symptoms of carotid disease. In the smaller aneurysms, ICA stenosis ≥70% occurs frequently, but without the symptoms of carotid disease, and there was no correlation between the size of AAA and the grade of ICA stenosis. Clinical implications of ICA imaging in patients with previously diagnosed AAA is necessary.

Prevalence and Severity of Asymptomatic Coronary and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm

“…Few studies 3,9,11,[15][16][17] investigated the prevalence of asymptomatic CAD or CeVD in patients with AAA. In a previous study, 3 the prevalence of significant CAD in patients with AAA was 71%, but this study included patients with previous MI and patients with typical angina pectoris.…”

“…6,7 This observation has implications for identification and treatment of underlying CAD before elective repair of AAAs, emphasizing the need of strategies for asymptomatic CAD and CeVD detection in patients with AAA. [8][9][10][11] Yet, the role of coronary angiography or noninvasive CAD or CeVD screening in patients with AAA without symptoms or history of CAD or CeVD is currently uncertain. These patients may have asymptomatic high risk of CAD or CeVD that should need prompt revascularization according to guidelines.…”

Medical and Revascularization Therapies for Asymptomatic Carotid Stenosis

“…A series of 757 patients with CABG showed a 26.4 % rate of moderate carotid stenosis and an 8.6 % rate of severe carotid stenosis [13]. Among patients with abdominal aortic aneurysms, severe asymptomatic carotid stenosis has been seen in 10.8 % [14].…”

Short version of the S3 guideline on screening, diagnosis, therapy and follow-up of abdominal aortic aneurysms

“…Kurvers et al [34] reported the prevalence of an internal carotid artery stenosis (ICAS) >70% in 8.8% of persons with AAA and recommended ICAS screening for AAA patients. In another study, the ICAS prevalence in patients with AAA was calculated at 10.8%, as a consequence of which preprocedural duplex sonography was recommended [35]. Reference can be made to the joint recommendation of the German Society for Anesthesiology and Intensive Care Medicine, the German Society of Surgery and the German Society of Internal Medicine for the preoperative evaluation of adult patients prior to elective, non-cardiothoracic surgery [36].…”