More coronary artery stenosis, more cerebral artery stenosis? A simultaneous angiographic study discloses their strong correlation

Abstract

Cerebral artery stenosis (CAS) has the same pathogenesis as coronary artery disease (CAD), but the coexistence of these two diseases has been rarely reported. To detect coexistent CAS in CAD patients, we conducted a study of simultaneous coronary and cerebral angiography. Of the 663 consecutive newly diagnosed CAD patients who had not yet been explored to have CAS, 80 were admitted to undergo angiography of bilateral carotid and vertebral system during the same procedure. We defined significant vascular stenosis, either located intracranially or extracranially, as the lesions of diameter stenosis more than 50%. Association between carotid or vertebral stenosis and their potential risk factors were also analyzed. Of our patients, 18 (22.5%) had significant extracranial vascular stenosis, 14 (17.5%) suffered from intracranial stenosis, and 20 (25%) had both. Only 28 patients (35%) had no significant intracranial or extracranial stenosis. None of the demographic parameters as hypertension or diabetes showed significant differences between the cerebral patent group and the CAS group, except for the number of coronary stenotic vessels (1.71 +/- 0.81 versus 2.69 +/- 0.64, P < 0.001). The number of coronary stenotic vessels is correlated well to the number of cerebral stenotic lesions (r = 0.562, P < 0.001). Besides, 8 of the cerebral stenotic patients and 2 of the cerebral patent patients had ischemic stroke previously. We conclude the CAS is coexistent in more than half of the CAD patients in this study. Our study also implies a proportional increase in the severity of CAS to CAD severity.

Severity of Coronary Artery Disease but Not Degree of Coronary Stenosis Is Correlated to Cerebrovascular Reactivity

“…The reported coincidence of coronary and cerebral ischemic stroke in population-based studies might be more likely reflected by the association between severity of CAD and CVR: it appears from the present data that the number of diseased coronary arteries more appropriately predicts the risk for an additional cerebrovascular involvement than the degree of CVD or the Gensini score [21]. In other words: atherosclerosis is a systemic disease with a heterogeneous focus in different vascular territories.…”

Feasibility of Low-Dose Contrast Medium High Pitch CT Angiography for the Combined Evaluation of Coronary, Head and Neck Arteries

“…Atherosclerosis is a common pathogenesis, a diffuse process that affects multiple vessels including the carotid and coronary arteries [3]. The coexistence rate of these two diseases has been reported at multiple imaging modalities, including digital subtraction angiography (DSA), Doppler ultrasonography (US), and multi-detector CT angiography (CTA) [3]–[6].…”

“…Atherosclerosis is a common pathogenesis, a diffuse process that affects multiple vessels including the carotid and coronary arteries [3]. The coexistence rate of these two diseases has been reported at multiple imaging modalities, including digital subtraction angiography (DSA), Doppler ultrasonography (US), and multi-detector CT angiography (CTA) [3]–[6]. CTA has emerged as a reliable tool in the evaluation of atherosclerotic disease and has been shown to have a high concordance with histology when characterizing carotid artery plaque [7]–[8].…”

Carotid Angiographic Profile in Patients with Coronary Artery Disease

“…8,9 The data from Asian countries is somewhat different, with studies showing that more than 50% of patients with CAD have associated significant CAS and vice versa. 10,11 In most of these studies carotid ultrasound/Doppler was used to identify and quantify CAS. Compared with selective intra-arterial DSA, color duplex sonography has an overall sensitivity of 91% to 95% and a specificity of 86% to 97% for diagnosing CAS, and therefore, false positive or negative results may be present in the data reported in these studies.…”

“…8,9 The data from Asian countries is somewhat different, with some studies showing that more than 50% of patients with CAD have associated significant CAS and vice versa. 10,11 Additionally, the distribution and severity of carotid atherosclerosis, as well as cardiovascular risk factor profile has been shown to demonstrate racial differences. 12 The presence of concomitant CAS in patients with CAD not only increases their overall cardiovascular risk but also has a significant impact on the choice of management strategy.…”