N. Bornstein
Neurology, Tel Aviv Sourasky Medical Center – Tel Aviv, Israel
Approximately 13 million deaths per year are caused by vascular diseases, ischemic heart disease and stroke account for 22.3% of the total yearly deaths in the world, 12.2% and 9.7% are due to ischemic heart disease and stroke respectively. Myocardial infarction is the leading cause of long-term mortality in stroke surviving patients, although stroke is the leading cause of disability in the world. Atherosclerotic carotid artery disease is the cause of ischemic ischemic stroke in about 20% of cases.
The aim of this lecture is to present the possibilities of predicting coronary artery disease in stroke patients.
The diagnosis of coronary artery disease (CAD) is often too late, because myocardial infarction or even death might be the first sign of CAD. In contrary to carotid artery disease where severity of the stenosis is the main player, rupture-prone plaques in coronary artery disease cause acute myocardial infarctions and sudden cardiac deaths.
About 68% of patients with acute myocardial infarction have a mild degree (<50%) of coronary artery stenosis. Approximately 76% of sudden cardiac deaths are caused by the rupture-prone plaque and only 24% by severe stenosis.
Asymptomatic carotid bruit increases the risk of myocardial infarction and cerebrovascular deaths. The noninvasive and reliable diagnostic tool for evaluating carotid artery atherosclerosis plaque or stenosis (CAS) is an ultrasound including measurement of intimal-media thickness (IMT) which represents mainly medial layer hypertrophy. IMT is usually measured in the common carotid artery and the internal carotid artery. In recent years, automated and semi-automated measurements of IMT were developed. According to Manheim consensus conference, measurement of IMT should be done on the far wall of the common carotid artery, with quality index greater than 0.5 (13, 14). IMT, plaque and stenosis should be regarded as distinct phenotypes, with distinct biological aspects and determinants.
Key words: coronary artery disease, prediction, stroke.