Occult carotid artery disease in patients who have undergone coronary angioplasty

OBJECTIVES: The aim was to evaluate the prevalence of asymptomatic mild (30-49%), moderate (50-69%) and severe (70-99%) ICA stenosis in patients who underwent previous coronary angioplasty (PTA). METHODS: After obtaining ethics committee approval, 144 consecutive patients aged between 65 and 75 years were invited for carotid Duplex evaluation with a linear 6 MHz array transducer by trained vascular sonographers within a single unit. A peak systolic velocity >230 cm/s in the ICA was considered as significant (>70% stenosis). RESULTS: Of the 144 patients approached, 117 (81%) attended (male:female ratio 3.2:1, age range 65-75 years, median age 71 years). Duplex ultrasound revealed one occlusion, 70% or more ICA stenosis in three patients (2.6%), 50-69% stenosis in 12 patients (10.3%) and 30-49% stenosis in 29 patients (24.8%). CONCLUSIONS: Carotid artery disease with a luminal stenosis of 30% or more is common in patients who underwent previous PTA. The yield of significant ICA stenosis (70% or more), which would benefit from carotid endarterectomy according to the Asymptomatic Carotid Surgery Trial is low. Recommendation for initial screening and subsequent follow-up Duplex examination for evaluation of disease progression of such cohorts remains debatable.