Occult carotid artery disease in patients who have undergone coronary angioplasty

a Departments of Vascular Surgery, King's College Hospital, London, UK b Departments of Vascular Laboratory, King's College Hospital, London, SE5 9RS, UK c Departments of Cardiology, King's College Hospital, London, UK *Corresponding author. Tel.: +44 203 299 3711/+44 7765010678; fax: +44 203 299 4379. E-mail address : hisham.rashid{at}kch.nhs.uk (H. Rashid). 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. Key Words: Carotid artery stenosis; Coronary angioplasty; Screening