Cardiological approaches to the diagnosis and treatment of patients with combined atherosclerotic stenosis of the carotid and coronary arteries

Abstract

Background. During the literature review, it becomes evident that approaches to the early diagnosis and treatment of atherosclerosis are undergoing significant changes worldwide. Unfortunately, isolated atherosclerotic involvement of a single vascular territory is rarely encountered nowadays. On the contrary, it is increasingly common to observe atherosclerotic lesions affecting multiple vascular beds in the same patient. From this perspective, modern advances in the diagnostics of multifocal atherosclerotic disease and novel approaches to the treatment of atherosclerosis have fundamentally altered the conventional understanding of this pathology.

Materials and methods. Within the framework of our study, we included 105 patients examined and treated from 2019 to 2024 at the Republican Specialized Center of Surgical Angioneurology. All had hemodynamically significant stenosis of the carotid arteries and were diagnosed with either asymptomatic ischemic heart disease or stable angina pectoris (Functional Class I–II). Patients underwent both standard and specialized diagnostic procedures, including ECG, 24-hour Holter ECG monitoring, echocardiography, ultrasound examinations, CT, MRI, angiography (MSCT angiography, coronary angiography), as well as myocardial MRI stress perfusion.

Results. In patients treated according to the developed algorithm, incidences of stroke, heart failure, acute coronary syndrome, and myocardial infarction were lower compared to the control group. In the main group, perioperative complications decreased to 2%, and long-term complications to 2.6%. Patient improvement was higher in the main group (53.9%) versus the control group (40.5%). A stratified approach in cases of combined carotid and coronary artery stenosis helped reduce complications and increase treatment efficacy.

Conclusion. Carotid artery stenosis accompanied by asymptomatic coronary lesions most often involves two or more diseased vessels; isolated atherosclerotic processes are rare. At least four risk factors are typically present, the most common being hypertension, obesity, physical inactivity, hyperlipidemia, or diabetes mellitus. When myocardial MRI stress perfusion indicates ischemia or shows a perfusion reserve 2, performing coronary stenting first can help prevent cardiac complications during carotid reconstruction.