Department of Cardiac Surgery, University of Manitoba, Winnipeg, MB R2H 2A6, Canada.
Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON K7L 2V7, Canada.
Medicina (Kaunas). 2023 Mar 16;59(3):586. doi: 10.3390/medicina59030586.
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients.
伴有皮质下梗死和白质脑病的常染色体显性遗传性脑动脉病（CADASIL）是成年人中最常见的遗传性血管性痴呆形式。已经确定 CADASIL 导致神经认知功能障碍和情绪障碍。还有越来越多的证据表明，CADASIL 患者更容易患缺血性心脏病。本研究旨在回顾关于 CADASIL 患者冠心病发病率的现有文献，重点关注各种管理选择以及这些治疗策略各自相关的临床挑战。我们使用 Cochrane、MEDLINE 和 EMBASE 进行了文献检索，以查找报告 CADASIL 患者冠心病发生情况的论文。我们在 Google Scholar 中进行了手动搜索以补充搜索。仅包括病例报告、病例系列和原始文章。搜索结果表明有六份报告表明 CADASIL 与冠心病之间存在关联及其治疗。有证据表明，CADASIL 的颅外表现可能包括冠状动脉疾病，在年轻患者中表现为更广泛的疾病负担。外科和经皮血运重建策略是可行的，但围手术期卒中的发生率仍然很高，应该权衡这些策略中的任何一种可能带来的益处。需要多学科的治疗方法，包括神经科医生、心脏病专家和心脏外科医生的观点，为患有严重冠心病的 CADASIL 患者提供适当的治疗。未来的研究应该针对开发靶向治疗方法，以帮助这些患者早期发现和预防疾病进展。
