Significance of selective carotid angiography during complete cardiac catheterization in patients candidates to combined aortic valve and carotid surgery.

AIM

Association of aortic valve stenosis (AVS) with carotid artery disease (CD) constitutes a high risk clinical setting for combined surgery. Carotid angiography is still considered the gold standard for carotid artery imaging, but its use is confined in cases of dubious or inconclusive sonographic examination. Despite the widespread use of ultrasonography, selective angiography may be practical in patients undergoing complete routine cardiac catheterization for AVS due to characteristic abnormalities in flow velocity pattern due to aortic valve stenosis. The present retrospective study aims to estimate the feasibility and role of carotid angiography during complete routine cardiac catheterization in the assessment of CD associated with AVS in patients candidates for combined surgery, in whom Doppler ultrasonography was inconclusive.

METHODS

In agreement with cardiac and vascular surgeons, patients aged >60 years, presence of risk factors, and inconclusive Doppler ultrasonographic examination underwent selective carotid artery angiography during complete cardiac catheterization. The angiographic and clinical records of these patients were reviewed.

RESULTS

Sixty patients (male/female 28/32, mean age 64.5+/-10.6 years) underwent carotid angiography during left and right catheterization. Optimal visualization of carotid trunk anatomy and morphology was achieved in all patients. Forty-one patients (68.3%) had no carotid artery atherosclerotic involvement, whereas 4 (6.6%) had low grade CD. Fifteen patients (8.3%, male/female: 7/8, mean age 70+/-10.4 years) were diagnosed with critical stenosis of one (14 patients) or both (1 patients) internal carotid arteries. The mean lesion degree was 77.1+/-2.1%. Culprit plaques, bifurcation lesion and occlusion have been discovered in 6.6%, 20%, and 26.6% of patients, respectively. Two arterial spasms (3.3%), and no intrahospital complications were observed.

CONCLUSION

In highly selected patients with combined CD and AVS and inconclusive Doppler ultrasonographic examination, selective carotid angiography during heart catheterization is safe, acceptably time-consuming and it may give an optimal anatomical picture of CD.