Original article Internal carotid artery stenosis in patients with degenerative aortic stenosis

Abstract

Background: In patients with severe degenerative aortic stenosis (DAS) the operative mortality risk is 3% for isolated aortic valve replacement (AVR), but it significantly increases in patients with concomitant coronary artery disease (CAD) and internal carotid artery stenosis (ICAS).
Aim: To assess the frequency of ICAS ł50% and factors determining its occurrence in patients with severe calcified DAS referred for AVR.
Methods: The study included 104 patients (67 men), aged 63.4±8.4 years, with symptomatic moderate-to-severe DAS (aortic valve area <1.5 cm²) undergoing coronary angiography prior to valve surgery. In all patients Doppler ultrasound of carotid arteries was performed with the assessment of lumen stenosis.
Results: Significant CAD, defined as at least one lumen reduction ł50% in a main coronary artery, was found in 44 (42.3%) patients and ICAS ł50% in 13 (12.5%) patients. Among patients with DAS, 12 (27.3%) out of 44 patients with significant CAD and 1 (1.7%) out of 60 patients without CAD had ICAS ł50% (p <0.001). The frequency of ICAS ł50% increased with advancing CAD, occurring in 4 (25%) out of 16 patients with 1-vessel CAD, 3 (25%) out of 12 with 2-vessel CAD and (31.3%) out of 16 patients with 3-vessel CAD (p <0.001). The independent ICAS predictors by multivariate regression analysis were identified as: concomitant CAD (p <0.001), diabetes (p=0.054), cigarette smoking (p=0.08) and decreased left ventricular ejection fraction (p=0.039). ICAS ł50% was found to be an independent predictor of CAD (p=0.002).
Conclusions: ICAS ł50% occurs in 13% of patients with isolated DAS and in 27% of those with DAS and CAD. Independent ICAS risk factors were identified as CAD, diabetes and cigarette smoking. Duplex ultrasound of carotid arteries should be considered in patients with DAS and concomitant CAD prior to AVR.