Abstract
Stroke is a rare but severe event after acute coronary syndrome. Relations between both arterial territories are still discussed but prevalence of asymptomatic carotid stenosis potentially implicated in the mechanism of stroke is under-investigated. This study aimed to determine the prevalence of asymptomatic carotid stenosis in that population and review the value of screening in a view to potential surgical correction or other preventive therapies. Systematic carotid Doppler ultrasound screening was implemented on 152 consecutive patients admitted to the intensive care unit due to acute coronary syndrome. Fifty-two percent of patients had at least one carotid artery stenosis determined using the NASCET method. Forty-three percent had at least one carotid stenosis <30%, 6% had mild (30–60%) stenosis, and 2.6% had high-grade (>60%) stenosis. Existence of carotid stenosis was associated with age, diabetes mellitus, hypertension, and with the extent of the coronary atherosclerosis (left main artery stenosis). In multivariate analysis, age and diabetes were independently associated with existence of a carotid stenosis. When ultrasound screening was restricted to patients identified by multivariate analysis, the prevalence of carotid stenosis potentially requiring surgical treatment rose to 4.6%. The frequency of asymptomatic carotid atherosclerosis was high in this population but lesions were mild. While the small number of high-grade lesions indicates that systematic screening is not to be recommended, screening of patients aged >65 years or with diabetes, or both, with a view to surgery may be envisaged, since the role of mild stenosis in the occurrence of stroke remains debatable.
Similar content being viewed by others
References
Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas J-L, Goto S, Liau C-S, Richard AJ, Rother J, Wilson PWF, for the RRI (2006) International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 295:180–189
Chaturvedi S, Bruno A, Feasby T, Holloway R, Benavente O, Cohen SN, Cote R, Hess D, Saver J, Spence JD, Stern B, Wilterdink J (2005) Carotid endarterectomy — an evidence-based review: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 65:794–801
Chimowitz MI, Mancini GB (1992) Asymptomatic coronary artery disease in patients with stroke. Prevalence, prognosis, diagnosis, and treatment. Stroke 23:433–436
Craven TE, Ryu JE, Espeland MA, Kahl FR, McKinney WM, Toole JF, McMahan MR, Thompson CJ, Heiss G, Crouse JR 3rd (1990) Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study. Circulation 82:1230–1242
Demircan S, Tekin A, Tekin G, Topcu S, Yigit F, Erol T, Katircibasi T, Sezgin AT, Baltali M, Ozin B, Muderrisoglu H (2005) Comparison of carotid intima-media thickness in patients with stable angina pectoris versus patients with acute coronary syndrome. Am J Cardiol 96:643–644
Komorovsky R, Desideri A, Coscarelli S, Cortigiani L, Tonello D, Visona A, Celegon L (2005) Predictive value of associations between carotid and coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 95:116–119
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr (2004) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction — executive summary. J Am Coll Cardiol 44:671–719
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE, III, Steward DE, Theroux P, Gibbons RJ, Alpert JS, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC Jr (2000) ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment elevation myocardial infarction. J Am Coll Cardiol 36:970–1062
Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction (2000) Myocardial infarction redefined — A consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. Eur Heart J 21:1502–1513
North American Symptomatic Carotid Endarterectomy Trial Collaborators (1991) Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 325:445–453
Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katarick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler E (2003) Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis — Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 19:190–198
Goldstein LB, Adams R, Alberts MJ, Appel LJ, Brass LM, Bushnell CD, Culebras A, DeGraba TJ, Gorelick PB, Guyton JR, Hart RG, Howard G, Kelly-Hayes M, Nixon JVI, Sacco RL (2006) Primary prevention of ischemic stroke: a guideline from the AHA/American Stroke Association Stroke Council. Circulation 113: e873–e923
CAPRIE Steering Committee (1996) A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 348:1329–1339
Aronow WS, Ahn C (1994) Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women > or =62 years of age. Am J Cardiol 74:64–65
Papamichael CM, Lekakis JP, Stamatelopoulos KS, Papaioannou TG, Alevizaki MK, Cimponeriu AT, Kanakakis JE, Papapanagiotou A, Kalofoutis AT, Stamatelopoulos SF (2000) Anklebrachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease. Am J Cardiol 86:615–618
Pasternak RC, Criqui MH, Benjamin EJ, Fowkes FG, Isselbacher EM, McCullough PA, Wolf PA, Zheng ZJ (2004) Atherosclerotic Vascular Disease Conference: Writing Group I: epidemiology. Circulation 109:2605–2612
Blakeley DD, Oddone EZ, Hasselblad V, Simel DL, Matchar DB (1995) Noninvasive carotid artery testing. A meta-analytic review. Ann Intern Med 122:360–367
Long A, Lepoutre A, Corbillon E, Branchereau A (2002) Critical review of non-or minimally invasive methods (duplex ultrasonography, MR-and CT-angiography) for evaluating stenosis of the proximal internal carotid artery. Eur J Vasc Endovasc Surg 24:43–52
Wardlaw JM, Chappell FM, Best JJ, Wartolowska K, Berry E (2006) Non-invasive imaging compared with intra-arterial angiography in the diagnosis of symptomatic carotid stenosis: a meta-analysis. Lancet 367:1503–1512
Kablak-Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M (2004) Association of increased carotid intima-media thickness with the extent of coronary artery disease. Heart 90:1286–1290
Fukuda I, Gomi S, Watanabe K, Seita J (2000) Carotid and aortic screening for coronary artery bypass grafting. Ann Thorac Surg 70:2034–2039
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study (1995) Endarterectomy for asymptomatic carotid artery stenosis. JAMA 273:1421–1428
Mohammed N, Anand SS (2005) Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomized controlled trial. MRC asymptomatic carotid surgery trial (ACST) collaborative group. Lancet 2004;363:1491–1502; Vasc Med 10:77–78
Budaj A, Flasinska K, Gore JM, Anderson FA Jr, Dabbous OH, Spencer FA, Goldberg RJ, Fox KA (2005) Magnitude of and risk factors for in-hospital and postdischarge stroke in patients with acute coronary syndromes: findings from a Global Registry of Acute Coronary Events. Circulation 111:3242–3247
Lombardo A, Biasucci LM, Lanza GA, Coli S, Silvestri P, Cianflone D, Liuzzo G, Burzotta F, Crea F, Maseri A (2004) Inflammation as a possible link between coronary and carotid plaque instability. Circulation 109:3158–3163
Redgrave JN, Lovett JK, Gallagher PJ, Rothwell PM (2006) Histological assessment of 526 symptomatic carotid plaques in relation to the nature and timing of ischemic symptoms: the Oxford plaque study. Circulation 113:2320–2328
Komorovsky R, Desideri A, Coscarelli S, Cortigiani L, Celegon L (2004) Impact of carotid arterial narrowing on outcomes of patients with acute coronary syndromes. Am J Cardiol 93:1552–1555
Komorovsky R, Desideri A, Coscarelli S, Cortigiani L, Tonello D, Visona A, Celegon L (2005) Prognostic implications of sonographic characteristics of carotid plaques in patients with acute coronary syndromes. Heart 91:819–820
Golledge J, Greenhalgh RM, Davies AH (2000) The symptomatic carotid plaque. Stroke 31:774–781
Erzen B, Sabovic M, Sebestjen M, Pavel P (2007) Endothelial dysfunction, intima-media thickness, ankle-brachial pressure index, and pulse pressure in young post-myocardial infarction patients with various expressions of classical risk factors Heart Vessels 22: 215–222
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fichet, J., de Labriolle, A., Giraudeau, B. et al. Reducing risk of stroke in patients with acute coronary syndrome: is screening for asymptomatic carotid disease useful?. Heart Vessels 23, 397–402 (2008). https://doi.org/10.1007/s00380-008-1065-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00380-008-1065-6