Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients.

PURPOSE: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors.

METHODS: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS> or =50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or < or =25%, 25-49%, and > or =50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded.

RESULTS: ECAS<70% in 42 patients and ECAS> or =70% in 141 patients. ICAS was found in 51 patients and ICAS> or =50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS.

CONCLUSIONS: We found ICAS in 27.8% of the patients with ECAS>50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.