| Background:Carotid artery stenosis (CAS) heart disease and Coronary artery disease (CAD) heart disease have the common pathological and physiological basis:the same Pathological and physiological status in different vascular areas. Atherosclerosis is the common and the most important disease in a set of Atherosclerotic vascular diseases, and the common characteristics of all kinds of arteriosclerosis are the thickening、hardening and losing elasticity of the artery wall and the narrowing of the lumen. Lesions mainly starts from arterial intima, successively with intima injury, accumulation of lipid and compound carbohydrate, bleeding and thrombosis, fibrous tissue hyperplasia and calcinosis, and gradually degeneration and calcification in middle layer of the artery. Acherosclerotic plaque is usually located in the outer layer of the artery bifurcation and easily forms in the boundary layer and the area bearing the low shearing pressure. Plaque clinical outcome mainly includes the limited bloodstream obstacle of the artery (significant stenosis), arteriectasis(formation of arterial aneurysm), the release of falling atheromatous plaque into the artery blood(embolism), finally lead to acute cardiovascular events.There are so many researches on the relationship between CAS and CAG. Graven and other scientists certificate the relationship between the carotid artery and coronary artery lesions. Artery atherosclerosis lesions of these two kinds of blood vessels often coexist and the correlation coefficient is between0.4and0.6. In the recent years, the clinical studies often test the IMT through Carotid artery doppler ultrasound to probe the relationship between them. Reminding the carotid atherosclerotic plaques is one of the predictive facture of the heart disease. Lorenz and other scientists research and find that if the absolute value of the IMT increases0.1mm, the happening risk of myocardial infarction will increase10%to15%. The studies of Salonen et al show that, comparing with patients without atherosclerosis, the possibility for atherosclerosis patients to suffer from acute myocardial infarction is3times higher; Kishimoto et al find that the thickening of IMT is obviously related to the aggravation of coronary heart disease (CHD). When IMT>1.15mm,94%of the patients are with CHD, and the CIMT of the triple vessel disease group is remarkably higher than that of the single vessel disease and double vessel disease, indicating that CIMT is related to the development of CHD.But compared with other high risk factures, it lacks the evidence of this aspect and needs more clinical study to support the following points that whether it is the high risk or low risk in the happening of the cardiovascular disease, whether the IMT is the end of clinical observation and whether it is the independent risk factor of atherosclerosis. But in2013,2013ACC/AHA Cardiovascular disease risk assessment guidelines issued by ACC and AHA also did not recommend to use the IMT test to assess the first happening of atherosclerotic cardiovascular disease.(ASCCVD includes nonfatal myocardial infarction, death of coronary heart disease and fatal or nonfatal apoplexy.)Based on the above pathological connections of the two, among CAS patients, the possibility of CAG combination shall be high suspected. An independent clinical evidence supports that there is something in common for the occurrence mechanisms of complications in carotid artery and coronary artery. According to the radiography result, the symptomatic CAS patients are divided into two groups by the regular carotid artery injuries and followed with a10-year follow-up visit. The result shows that, the possibility for the patients with irregular carotid artery injuries to suffer from non-stroke vascular death (mainly referring to coronary artery event) is two times higher than that of the lesion smooth group.The remote hazard of CAS, especially internal CAS, is concurrent cerebral ischemic stroke. When there is only CAG, not only the occurrence rate of cardio-cerebrovascular complications, but also the risk for intervening CAS into the operation during the perioperative period increases remarkably; if the patient has no clinical symptoms of CAG in the past, it shall be particularly noted. The difference between silent myocardial ischemia (SMI)(latent coronary heart disease, CHD) and other types of CAG is that there is no clinical manifestation; that is not only atherosclerosis, but also the pathologic changes of myocardial ischemia; this part of patients may suddenly turn as angina or acute myocardial infarction due to CHD at the early stage. Among all the myocardial infarction patients not clinically recognized, nearly half are really asymptomatic. Especially type-I asymptomatic ischemia, it has no angina symptom clinically. Although it is rare clinically, it can be quite severe. When this part of patients are found out and provided with early treatment opportunities, their risks for suffering from acute cardiovascular affair can be obviously reduced.While for patients planning to receive the carotid artery interventional therapy, observing CAG to further understand the coronary artery situation, and finding potential asymptomatic CAS or severe CAS that was not seriously noted before, etc. to further evaluate the operation risk, adjust the treatment strategy can remarkably reduce the risks during the perioperative period and benefit the patients.However, as seen from the perspective of severe CAS, the relations with CAD is that:among the patients with severe CAS, the reports on the occurrence rate, order of severity, distribution characteristics of CAS and their dependency are rarely found.Especially for patients requiring CAS interventional therapy, it is quite important to know and evaluate the significance of coronary angiography. The study aims to conduct normal coronary angiography on patients with severe CAS and received interventional therapy, so as to explore the relationship among them.Objective:To discuss the meaning of using CAG before operation to the serious CAS patients who accept interventional therapy and master the illness condition of the patients who suffer from carotid artery stenosis and carotid artery stenosis. To understand the stenosis level, the relative relationship between the distribution of the blood vessels and the carotid artery and coronary artery,and analysis the whole treatment influence to the patient.Methods:Select197patients who suffer from serious CAS patients who accept carotid artery interventional therapy from June,2002to October,2013. And all the patients conduct routine CAG before carotid artery interventional therapy.The standard of CAS is calculated according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) passed on the Ultrasound Conference of the Radiological Society of North America (RSNA) in2003; the degree of CAS is shown according to the stenosis degree of the inner diameter of the coronary artery. According to the radiography result, the CAS degree is over70%(the stenosis degree of the coronary artery has mostly been made clear before the interventional treatment).The quantity of CAD is calculated by the three systems, i.e., left coronary artery anterior descending branch (LAD), left circumflex coronary artery (LCX) and right coronary artery (RCA), and angle branch disease is reckoned in LAD, blunt branch is reckoned in LCX, and left ventricular branch and posterior descending branch diseases are reckoned in RCA. The major visceral pericardium artery with obvious stenosis (>50%diameter stenosis) is defined as CAD, among which the>75%diameter stenosis is considered with clinical significance and require further intervention, otherwise, it shall be deem as non-stenosis or negative. The degrees of CAS are classified by<50%stenosis,50-75%stenosis and>75%stenosis.Based on the above stenosis degree judgment standard, the grouping is done according to the stenosis disease number. The CAS is counted according to the different accumulative numbers of internal and external arteries such as unilateral and bilateral lesions.the coronary arteries are consequently divided as none, single, double, triple, and combined left main coronary artery, etc.Then divide them into different groups according to the angiogram results of the stenosis level, the distribution of the blood vessels of the carotid artery and coronary artery.All the clinical data is input into the Epidata system in duplicate separately for the convenience of consistency detection. Meanwhile, SPSS software is adopted to conduct statistical analysis. Show all measurement data by using+/-SD. Check the count data comparison by using χ2. Check the measurement data comparison by using t of the two independent simple. And regard α<0.05as the significant difference level. Compare the date in different groups and check whether they have relationship by using Kruskal Wallis H test. so as to further conduct Spearman correlation coefficient analysis and Kendall correlation coefficient analyses. Adopt linear regression analysis to the number of lesions blood vessels of Carotid stenosis and Coronary artery stenosis.Regard the classification variables that the patients who suffer from carotid stenosis with coronary heart disease or not as the dependent variable and regard the number of lesions blood vessels of Carotid stenosisto as independent variables to analyze risk factors.Results:1. The following are the situations of CAG and CAS existing in the same person. The number of CAG reminding CAD is155(account for78.68percent), CAS and CAD existing at the same is42(account for78.68percent), only CAS existing is42(account for21.32percent). The average age of the people who suffer from CAD and CAS is69and the people who only suffer from CAS is69.17. The average total cholesterol level of the CAS combined CAD group is4.43mmol/l, the average triglyceride is1.46mmol/l, and the average glycosylated hemoglobin is7.27%; the average age of the CAS combined noh-CAD group is69.17, while the average total cholesterol level is3.92mmol/l, the average triglyceride is1.22mmol/l, and the average glycosylated hemoglobin is6.36%.2. Carotid artery stenosis disease we divided into unilateral and bilateral lesiongroup:Based on the CAG extent of coronary stenosis (less than50%,50-75%, more than75%) are grouped.Is single or double side pathological changes of carotid stenosis and coronary artery stenosis degree of correlation. According to the results of unilateral carotid artery lesion group and bilateral lesions in the coronary artery narrow distribution overall statistically significant difference (P<0.05), which can be thought unilateral lesion group, distribution is different from the bilateral stenosis of coronary lesion group.3. Divide into different groups according to the number of coronary artery lesions (none, single, double, three, with left main coronary artery). Compare the number of lesion blood vessel (unilateral and bilateral lesions) in carotid artery stenosis and in coronary artery. After the Kruskal Wallis H checking, we found that there was significant statistical meaning between the number of lesion blood vessel in carotid artery stenosis and in coronary artery.(P=0.008)4. Regard whether the classified variate CAS is with CAD or not as the dependent variable. After the correction of factors such as gender, age, hypertension history, smoking history, drinking history, blood glucose and blood fat, the number of arteries with CAS disease cannot be taken as the independent risk factor of CAS combined CAD, and the difference is without any statistical significance.Conclusion:Severe CAS has extremely high overall coexistence rate of CAD. The number of arteries of CAS disease is positively correlated to the number of arteries of CAD disease. The risk factors of CAS and CAD are close with each other. Conducting CAG evaluation of the coronary artery situation during the CAS interventional treatment and diagnosis has directive significance on the comprehensive strategy of the perioperative period. Carotid stenosis in diagnosis and treatment of the CAG has a high necessity... |
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