Abstract
Objective: Coronary artery disease (CAD) is a major comorbidity usually developing in patients with carotid artery stenosis and increases the risk of revascularization in these patients. We retrospectively evaluated the impact of CAD on the outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS) at a single center. Methods: We reviewed data of 643 lesions (451 CEA and 192 CAS) in 599 patients who underwent carotid revascularization at our institute between 1998 and 2011. We defined a history of myocardial infarction (MI), coronary artery bypass surgery, or percutaneous coronary intervention as previous CAD and >75% stenosis in more than 2 coronary artery areas as multivessel CAD. Periprocedural stroke, MI, or death from any cause and ipsilateral stroke, MI, or death within a year after treatment were recorded. Results: Of the 643 lesions, 123 (19.1%) were categorized as “previous CAD” and 73 (11.4%) as “multivessel CAD.” The number of cases of multivessel CAD was significantly higher in the CAS group than the CEA group (14.5% vs. 9.9%, p = 0.009). Of the 102 cases indicated for coronary intervention at a preoperative period, 85 were treated for CAD before carotid revascularization. No periprocedural MI was observed in both the groups, and only 1 case showed MI within a year after CEA (0.2%). The CEA group showed no significant relationship between previous or multivessel CAD and any periprocedural or 1-year postoperative event. In the CAS group, multivessel CAD was identified as an independent risk factor for periprocedural stroke (odds ratio [OR]: 11.23; 95% confidence interval [CI]: 2.96-48.91; p = 0.0004) and ipsilateral stroke and death within a year of treatment (OR: 6.76; 95% CI: 2.09-22.38; p = 0.001). Conclusion: Previous or multivessel CAD did not increase the risk of MI or death within 1 year after revascularization of carotid artery stenosis, but multivessel CAD was an independent risk factor for stroke after CAS. Thus, the option of CAS should be carefully considered in cases of carotid artery stenosis with multivessel CAD.
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