R E V I E W Carotid ultrasound assessment of patients with coronar y ar ter y disease: a useful index for risk stratification Roman Komorovsky Alessandro Desideri Cardiovascular Research Foundation, S Giacomo Hospital, Castelfranco Veneto, Italy Correspondence: Roman Komorovsky Cardiovascular Research Foundation, Ospedale S Giacomo, 31033 Castelfranco Veneto (TV), Italy Tel +39 0423 732 306 Fax +39 0423 732 301 Email roman_komor@yahoo.com Abstract: Carotid disease is a common finding in patients with coronary artery disease (CAD) and its presence is associated with worse clinical outcomes. Intima-media thickness provides incremental value over traditional risk factors in predicting cardiovascular events; however, it does not predict the absence of CAD or its extent and severity. The presence of carotid plaques is associated with an increased risk of cardiovascular events in patients with CAD regardless of the treatment strategy (medical therapy alone or myocardial revascularization). Hence, we advocate the screening of patients with diagnosed CAD for carotid atherosclerosis. The prognostic impact of ultrasound characteristics of carotid plaques on cardiovascular outcomes of patients with CAD remains controversial. Keywords: intima-media thickness, carotid plaques, coronary artery disease, ultrasound Introduction The coexistence of carotid and coronary artery disease (CAD) is a challenge to cardiologists, vascular and cardiothoracic surgeons, and neurologists. Patients with coexistent narrowing of carotid and coronary arteries represent a particularly high- risk group and to date there has been no consensus with regard to their management. Carotid endarterectomy in these patients is associated with an increased incidence of perioperative myocardial infarction (Biller et al 1998), and coronary artery bypass grafting is accompanied by an elevated risk of neurological injury (Jones et al 1984). Epidemiological data While in a general adult population the prevalence of carotid stenosis approaches 4% (Mathiesen, Joakimsen, et al 2001), in patients with coronary artery disease it can reach 30%–70% (Kallikazaros et al 1999; Held et al 2001; Komorovsky et al 2004; Lombardo et al 2004). For those undergoing coronary artery bypass grafting, the prevalence of > 50% narrowing of at least one internal carotid artery is thought to be around 20%, and > 70% carotid stenosis is found in 2%–12% of cases (Schwartz et al 1995; Evangelopoulos et al 2000). Carotid artery disease as a marker of increased risk of cardiovascular events Carotid artery disease, even in its preclinical stage (intima-media thickness [IMT] ≥ 1 mm and non-obstructive [< 50%] carotid plaques), has been associated with CAD and an increased risk of cardiovascular events. Vascular Health and Risk Management 2005:1(2) 131–136 © 2005 Dove Medical Press Limited. All rights reserved 131