Noninvasive assessment of stenotic severity and plaque characteristics by coronary CT angiography in patients scheduled for carotid artery revascularization

Aims: Coronary artery atherosclerosis in patients needing carotid revascularization has not been fully clarified. The aim of this study was to evaluate the stenotic severity and plaque characteristics of coronary arteries by coronary computed tomography angiography (CTA) in patients scheduled for carotid-artery stenting (CAS) or carotid endarterectomy (CEA). Methods: We performed coronary CTA after carotid ultrasound (US) in 164 patients (81.7% male, aged 68.1± 12.2 years) from 2014 to 2016. Of all, 70 were scheduled for CAS or CEA (CAS/CEA group) and 94 were not (non-CAS/CEA group). Carotid US and coronary CTA were compared for the evaluation of stenotic severity and plaque characteristics of each vessel between CAS/CEA and non-CAS/CEA groups. Results: Between the two groups, there were significant differences in the presence of significant stenosis (SS: ≥ 70% stenosis of coronary artery) (55.7% vs. 39.4%, P =0.038), triple-vessel disease (TVD)/left main trunk (LMT) (SS in each of three epicardial vessels and/or LMT) (24.3% vs. 7.5%, P = 0.0025), and high-risk plaque (HRP: positive remodeling and/or low attenuation) (55.7% vs. 24.5%, P ＜0.0001). CAS/CEA was independently associated with TVD/LMT (OR ₌ 2.30, 95%CI: 1.14 – 8.59, P ₌ 0.026) and HRP (OR ₌ 3.17, 95%CI: 1.57 – 6.54, P ₌ 0.0012) in multivariable logistic regression analysis. Similarly, vulnerable plaque (78.6% vs. 2.1%, P ＜0.0001) as well as severe stenosis of carotid artery (98.6% vs. 0%, P ＜0.0001) was seen more often in CAS/CEA than in non-CAS/CEA group. Conclusions: The prevalence of TVD/LMT and HRP determined by coronary CTA is higher in patients needing CAS/CEA than in those without. Management of systemic atherosclerosis is required in the perioperative period of CAS/CEA.