Key result
Patients with severe carotid stenosis and concomitant coronary artery stenosis had significantly higher global cardiovascular and hemodynamic risk scores compared to those with isolated carotid stenosis.
Why the study?
Do composite cardiovascular risk scores and hemodynamic parameters correlate with the extent of multisystem vascular disease in patients with severe carotid stenosis?
Observational (n=170)
Do composite cardiovascular risk scores and hemodynamic parameters correlate with the extent of multisystem vascular disease in patients with severe carotid stenosis?
Absolute Event Rate: 5.8% vs 4.29%
p-value: p=0.016
In patients with severe carotid stenosis, the presence of concomitant coronary or peripheral arterial disease is associated with significantly higher composite cardiovascular risk scores and worse left ventricular ejection fraction.
Concomitant coronary stenosis was associated with higher risk scores in carotid disease; leaves open whether composite scores improve multisystem risk stratification.
Background. Atherosclerosis is a systemic disease involved in cerebrovascular disease (CVD), coronary arterial disease (CAD), and peripheral arterial disease (PAD). Atherosclerotic carotid artery stenosis is an important cause of ischemic stroke, accounting for approximately 20-30% of all ischemic strokes. Carotid endarterectomy (CEA) and Carotid angioplasty stent (CAS) are interventional treatment for symptomatic and asymptomatic patients with severe carotid artery stenosis. Purpose. The purpose of this study was to evaluate the prognostic and treatment criteria in patients with severe carotid uni/bilateral stenosis in different circumstances: symptomatic/asymptomatic, with recent or old ischemic stroke, candidates for (CEA) or stent (CAS), with/without involvement of coronary arteries and peripheral endothelial function. Material and methods. The study included 85 patients with severe carotid stenosis (over 70%) that have been evaluated for CEA or CAS. Patients were evaluated with Carotid Doppler and/or Angio CT of the cervical region, cardiac ultrasound and cerebral/coronary/peripheral angiography, thus assessing the degree of coronary and peripheral involvement. The following have been calculated: ejection fraction (EF) (%), telediastolic volume (TDV) (ml), overall cardiovascular risk - blood pressure score (Score BP), (ranging 1-4 according to severity) and 2 composite scores: global cardiovascular and hemodynamic risk score (GCVHRS), (ranging 1-10 according to risk factors summation) and organic vascular risk score (OVRS), (ranging 1-10 according to the number and topographic status of stenosis). Patients were divided into four groups: a) with carotid stenosis only (CaAS), b) with CaAS damage and coronary stenosis (CoAS), c) with CaAS damage and peripheral stenosis (PAS) and d) global vascular involvement (CaAS,CoAS,PAS). All study patients were compared with 85 matched patients with cardiovascular risk factors without signs of clinical organ damage. Results. Among the 85 patients with severe carotid stenosis, 52 (61.2%) patients had ICA stenosis between 90%-99%, 37 (43.5%) patients had CaAS involvement and 14(16.5%) patients had multiple organ vascular damage. GCVHRS was significantly higher in the patient group with both CaAS and CoAS (scoring 5.80+/-2.33*) and also OVRS in patients with severe multiple organ vascular involvement (scoring of 6.78+/-1.42*), compared to the other groups of patients (p < 0.05). The hemodynamic risk evaluation in CaAS had a EF mean of 52.27+/-7.56 (%) and a TDV mean of 92.13+/-30.27* (ml) while in the global vascular involvement group EF dropped to a mean of 45.71+/-13.56 (%) and TDV increased to a mean of 124.28+/-51.38 (ml). Conclusions. Higher composite scores (GCVHRS and OVRS) and decrease of EF best correlated with: the degree of carotid stenosis, with the presence of left internal carotid involvement, with the presence of a contralateral involvement (stenosis/occlusion). Secondary vascular disease prevention is mandatory in patients with carotid, coronary and peripheral arterial disease. A composite vascular risk evaluation is useful for individually tailoring our interventional treatment strategy thus improving the global functional outcome of any given patient.*P < 0.05
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Militaru et al. (2014) conducted an observational in Severe carotid artery stenosis (n=170). Severe carotid artery stenosis with concomitant coronary artery stenosis vs. Isolated severe carotid artery stenosis was evaluated on Global cardiovascular and hemodynamic risk score (GCVHRS) (p=0.016). Patients with severe carotid stenosis and concomitant coronary artery stenosis had significantly higher global cardiovascular and hemodynamic risk scores compared to those with isolated carotid stenosis.
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