The prevalence of carotid artery stenosis in patients undergoing aortic reconstruction

BACKGROUND: Coronary artery disease occurs frequently in patients undergoin g aortic reconstruction, and it has been presumed that internal carotid art ery occlusive disease is also common. This has led to the practice of scree ning for and repairing significant carotid lesions in asymptomatic patients prior to aortic reconstruction. The purpose of this study was to determine the true prevalence of internal carotid artery disease in these patients, METHODS: The records of 240 patients who underwent duplex ultrasound screen ing for carotid artery disease prior to aortic reconstruction were reviewed , Surgery was performed for aortic aneurysm (AA) or aorto-iliac occlusive d isease (AO). The prevalence of hyperlipidemia and coronary artery disease w as similar between the two groups, but tobacco use, hypertension, and diabe tes mellitus differed. RESULTS: Internal carotid artery stenosis greater than or equal to 50% occu rred in 26.7% of the total group (64 of 240 cases). Stenosis greater than o r equal to 50% was move common in the AO group (40 of 101 cases, 39.60%) th an the AA group (24 of 139 cases, 17.3%, P = 0.0001). Severe disease (70% t o 99%) was also more common in the AO group than the AA group (9.9% versus 3.6%, P = 0.0464). CONCLUSION: internal carotid artery disease occurs commonly in patients und ergoing aortic reconstruction, and screening is worthwhile. Significant dis ease is more common in patients with aorto-iliac occlusive disease than in those with aortic aneursym, although atherosclerotic risk factors occur wit h varying frequency in the two groups. These findings suggest that addition al factors may contribute to the higher prevalence of internal carotid arte ry stenosis in aorto-iliac occlusive disease. (C) 1999 by Excerpta Medica, Inc.