Indications for carotid screening in patients with coronary artery disease.
Presse Med. 2009 Jun;38(6):977-86
Authors: Aboyans V, Lacroix P
We reviewed the literature about the usefulness of screening for carotid artery lesions in patients with coronary artery disease (CAD). The use of duplex ultrasonography to detect carotid lesions has a two-fold interest in this situation. First, it enables the detection of severe carotid artery stenosis (CS), a potentially reversible cause of stroke. Stroke is frequent in patients with CAD, accounting for at least in one-fourth of all cardiovascular events during follow-up. The mean prevalence of CS > 60% in patients with CAD is 9%, too low to justify routine carotid screening. However, older age, history of a cerebrovascular event, and peripheral arterial disease are useful factors for focusing screening on a high-risk subset of patients with CAD. Trials assessing the interest of prophylactic carotid surgery in asymptomatic CS of 60% or more found similar benefits in the subset of patients with CAD. Screening for CS in patients undergoing coronary artery bypass grafting is also important because CS is a marker, and sometimes the source, of perioperative stroke. Unfortunately, randomized studies to determine the best strategy in this situation are lacking. Second, while measurement of the carotid intima-media thickness does not provide substantial prognostic information for patients with CAD, the presence of plaque, especially hypoechogenic or echolucent (lipid-rich) plaque, is associated with an unstable or high-risk cardiovascular status. In this situation, specific studies are warranted to compare carotid imaging with biomarkers such as C-reactive protein and stratify the cardiovascular risk.
PMID: 19376684 [PubMed - indexed for MEDLINE]