Screening for carotid stenosis in patients with ischaemic heart disease

In screening for carotid stenosis, an oblique cervical intra-arterial digital subtraction angiogram (IA-DSA) was obtained in 30 consecutive patients who underwent coronary angiography for work-up of myocardial infarction and/or follow-up of the status of previous percutaneous transluminal coronary angioplasty (PTCA) or revascularization (PTCR). In cases where carotid artery stenosis was suspected from IA-DSA, conventional angiography was obtained concurrently. Of 30 cases, three cases of severe carotid artery stenosis were detected. Carotid artery stenoses were in the right carotid bifurcation, and the extents of the stenoses were 70%, 75% and 90%. Ulceration was seen in the case with 75% stenosis. There were no complications associated with the coronary angiography, nor with the additional cervical IA-DSA which required less than 5 min to perform in all cases. Patients with ischaemic heart disease are a high risk group for carotid stenoses. This method of screening carotid stenosis is safe and requires only 20 ml of additional contrast media giving excellent resolution. The value of performing cervical IA-DSA in patients undergoing coronary angiography to screen for carotid stenosis is discussed.