Relation Between Syntax Score and Complexity of Carotid Artery Disease

Öz

Introduction: Carotid artery disease may cause severe constriction or complete occlusion in carotid arteries, it may not give any symptoms until it appears. In some people, stroke is the first finding of the disease. One of the most important causes of stroke is carotid artery stenosis and atherosclerosis causes a total of one third of the stroke. Atherosclerosis; It is a specific finding of both coronary and carotid artery disease.The relationship between carotid atherosclerotic diasease and coronary artery disease (CAD) have been in previous reports Aim: In this study, we aimed to show the relationship between the severity of the carotid artery stenosis(CAS) determined by angiography and the anatomical complexity of CAD assessed by SYNTAX Score (SS). Material and Methods: Our study was carried out in accordance with the Declaration of Helsinki Principles by obtaining the ethics committee approval dated 09.06.17 and numbered E.8640. A total of 45 patients with simultaneously carotid and coronary angiography performed were included in our study. SS, a marker of CAD complexity, was determined by dedicated computer software. The patients were divided into two groups according to the classification of SS: low SS (n=33, SS <22) and intermediate-high SS (n=12, SS ≥22) groups. The severity of CAS was assessed by digital subtraction angiography (DSA) of six distinct segments of the carotid artery included the left and right common, internal, and external carotid arteries. Spearman’s correlation coefficients were used to determine the correlations between SS and CAS score. Results: The CAS severity score was significantly higher in patients with intermediate and high SS group than in the low SS group (3/4/4.75 vs. 1/2/3, p=0.001). There was also significant correlation between SS and CAS severity score (r=0.47, p=0.001). Conclusions: We revealed that there was a proportional increase in the severity of CAS to CAD complexity using SS. It may suggest that complex multivascular atherosclerotic disease is the systemic nature of atherosclerosis.

Anahtar Kelimeler

• Carotis Artery Stenosis
• Coronary Artery Disease
• Constriction
• Stroke
• SyntaxScore

Karotis Arter Hastalığı Şiddeti ile Syntax Skoru Arasındaki İlişki

Öz

Giriş: Karotis arter hastalığı, karotis arterlerde şiddetli daralmaya veya tam tıkanmaya neden olabilir, ortaya çıkana kadar herhangi bir belirti vermeyebilir. Bazı kişilerde, hastalığın ilk bulgusu inmedir. İnmelerin en önemli nedenlerinden biri karotis arter stenozudur (KAS) ve toplam inmelerin üçte birine atheroskleroz neden olur. Atheroskleroz; hem koroner ve hem de karotis arter hastalığının spesifik bulgusudur. Aterosklerotik karotis hastalığı ile koroner arter hastalığı (KAH) arasındaki ilişki önceki çalışmalarda gösterilmiştir. Amaç: Bu çalışmada anjiyografi ile değerlendirilen karotis arter darlığının şiddeti ile SYNTAX Skoru (SS) ile değerlendirilen KAH' nın anatomik kompleksliği arasındaki ilişkiyi göstermeyi amaçladık. Materyal Metod: Çalışmamız 09.06.17 tarih ve E.8640 sayılı etik kurul onayı alınarak, Helsinki İlkeler Deklarasyonu’na uygun olarak gerçekleştirilmiştir. Çalışmamıza eş zamanlı olarak karotis ve koroner anjiyografi yapılan toplam 45 hasta dahil edildi. KAH kompleksliliği özel bir bilgisayar yazılımı olan SS ile belirlendi. Hastalar SS sınıflamasına göre iki gruba ayrıldı: düşük SS (n = 33, SS <22) ve orta-yüksek SS (n = 12, SS ≥22) grupları. KAS şiddeti, karotis arterlerin sol ve sağ carotis communis, internal ve external bölümlerini içeren altı farklı segmentinin dijital subtraksiyon anjiyografisi (DSA) ile değerlendirildi. SS ile KAS şiddeti arasındaki korelasyonları tespit etmek için Spearman korelasyon katsayıları kullanıldı. Bulgular: KAS, orta ve yüksek SS grubunda, düşük SS grubuna göre anlamlı derecede yüksekti (3/4/4.75 vs. 1/2/3, p=0.001). SS ve KAD ciddiyeti arasında anlamlı korelasyon vardı (r=0.47, p=0.001). Sonuç: Çalışmamız ile SS kullanarak KAD ile KAS şiddetinde orantılı bir artış olduğunu gösterildi. Karmaşık multivasküler aterosklerotik hastalığın, aterosklerozun sistemik doğası olduğunu düşündürebilir.

Anahtar Kelimeler

• Karotis Arter Darlığı
• Koroner Arter Hastalığı
• Konstriksiyon
• İnme
• Syntaks Skoru

Kaynakça

1. 1. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med 1999;340:115–26.
2. 2. Rundek T, Arif H, Boden-Albala B, Elkind MS, Paik MC, Sacco RL. Carotid plaque, a subclinical precursor of vascular events: the Northern Manhattan Study. Neurology. 2008;70:1200-7.
3. 3. Steinvil A, Sadeh B, Arbel Y, Justo D, Belei A, Borenstein N, et al. Prevalence and predictors of concomitant carotid and coronary artery atherosclerotic disease. J Am Coll Cardiol 2011;57:779-83.
4. 4. Touzé E, Varenne O, Calvet D, Mas JL. Coronary risk stratification in patients with ischemic stroke or transient ischemic stroke attack. Int J Stroke 2007;2:177-83.
5. 5. D’Agostino RB, Russell MW, Huse DM, et al. Primary and subsequent coronary risk appraisal: new results from the Framingham study. Am Heart J 2000; 139:272-81.
6. 6. Timaran CH, Rosero EB, Smith ST, Valentine RJ, Modrall JG, Clagett GP. Trends and outcomes of concurrent carotid revascularization and coronary bypass. J Vasc Surg 2008;48:355-61.
7. 7. Hankey GJ, Slattery JM, Warlow CP. Transient ischaemic attacks: which patients are at high (and low) risk of serious vascular events? J Neurol Neurosurg Psychiatry 1992; 55: 640–52.
8. 8. Touzé E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke 2005; 36:2748-55.

9. 9. Chimowitz MI, Weiss DG, Cohen SL, Starling MR, Hobson 2nd RW. Cardiac prognosis of patients with carotid stenosis and no history of coronary artery disease. Veterans Affairs Cooperative Study Group 167. Stroke 1994; 25:759-65.
10. 10. Aboyans V, Lacroix P. Indications for carotid screening in patients with coronary artery disease. Presse Med 2009;38:977-86.
11. 11. Sianos G, Morel MA, Kappetein AP, Morice MC, Colombo A, Dawkins K, Van den Brand M, Van Dyck N, Russell ME, Mohr FW, Serruys PW. The SYNTAX Score: an angiographic tool grading the complexity of coronary artery disease. EuroIntervention. 2005;1:219-27.
12. 12. Costanzo L, Campisano MB, Capodanno D, Sole A, Grasso C, Ragusa M, Ronsivalle G, Tamburino C, Tamburino C, Di Pino L. The SYNTAX score does not predict presence of carotid disease in a multivessel coronary disease population. Catheter Cardiovasc Interv. 2014;83:1169-75.
13. 13. Ikeda N, Kogame N, Iijima R, Nakamura M, Sugi K. Carotid artery intima-media thickness and plaque score can predict the SYNTAX score. Eur Heart J. 2012;33:113-9.
14. 14. Ikeda N, Gupta A, Dey N, Bose S, Shafique S, Arak T, Godia EC, Saba L, Laird JR, Nicolaides A, Suri JS. Improved correlation between carotid and coronary atherosclerosis SYNTAX score using automated ultrasound carotid bulb plaque IMT measurement. Ultrasound Med Biol. 2015;41:1247-62.
15. 15. Korkmaz L, Bektas H, Korkmaz AA, Agaç MT, Acar Z, Erkan H, Celik S. Increased carotid intima-media thickness is associated with higher SYNTAX score. Angiology. 2012;63:386-9.
16. 16. Tendera M, Aboyans V, Bartelink ML, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 201; 32: 2851-906.
17. 17. Ferguson GG, Eliasziw M, Barr HW, et al. The North American Symptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999; 30: 1751-8.
18. 18. Long TH, Criqui MH, Vasilevskis EE, Denenberg JO, Klauber MR, Fronek A. The correlation between the severity of peripheral arterial disease and carotid occlusive disease. Vasc Med. 1999;4:135-42.
19. 19. SYNTAX score calculator. Available at: http:/www.syntaxscore.com.SYNTAX working-group. Accessed May 2013.
20. 20. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, Ståhle E, Feldman TE, van den Brand M, Bass EJ, Van Dyck N, Leadley K, Dawkins KD, Mohr FW; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009;360:961-72.
21. 21. Stamou SC, Hill PC, Dangas G, et al. Stroke after coronary artery bypass: incidence, predictors, and clinical outcome. Stroke 2001;32: 1508–13.
22. 22. Biller J, Feinberg WM, Castaldo JE, Whittemore AD, Harbaugh RE, Dempsey RJ, Caplan LR, Kresowik TF, Matchar DB, Toole JF, Easton JD, Adams HP Jr, Brass LM, Hobson RW II, Brott TG, Sternau L. Guidelines for carotid endarterectomy: a statement for healthcare professionals from a Special Writing Group of the Stroke Council, American Heart Association. Circulation. 1998;97:501–509.
23. 23. Aichner FT, Topakian R, Alberts MJ, et al. High cardiovascular event rates in patients with asymptomatic carotid stenosis: the REACH Registry. Eur J Neurol 2009;16:902–8.
24. 24. Kallikazaros I, Tsioufis C, Sideris S, Stefanadis C, Toutouzas P. Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke. 1999;30:1002-7.
25. 25. Tanimoto S, Ikari Y, Tanabe K, Yachi S, Nakajima H, Nakayama T, Hatori M, Nakazawa G, Onuma Y, Higashikuni Y, Yamamoto H, Tooda E, Hara K. Prevalence of carotid artery stenosis in patients with coronary artery disease in Japanese population. Stroke. 2005;36:2094-8.
26. 26. Taggart DP. Lessons learned from the SYNTAX trial for multivessel and left main stem coronary artery disease. Curr Opin Cardiol 2011; 26: 502– 507.
27. 27. Sibal L, Agarwal SC, Home PD. Carotid intima-media thickness as a surrogate marker of cardiovascular disease in diabetes. Diabetes Metab Syndr Obes. 2011;4:23-34.
28. 28. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421-8.
29. 29. The European Carotid Surgery Trialists Collaborative Group. Risk of stroke in the distribution of an asymptomatic carotid artery. Lancet 1995;345: 209-12.
30. 30. Filis KA, Arko FR, Johnson BL, et al. Duplex ultra- sound criteria for defining the severity of carotid stenosis. Ann Vasc Surg 2002; 16:413–21.
31. 31. Papadopoulos K, Lekakis I, Nicolaides E. The Predictive Value of the Syntax Score in Patients With Chronic Coronary Artery Disease Undergoing Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting: A Pilot Study. The Open Cardiovascular Medicine Journal, 17 Apr 2017, 11:28-32.
32. 32. Ozturk S, Sahin M. Syntax Score I and II for Predicting Carotid Artery Stenosis in Patients with Multivessel Coronary Artery Disease: A Propensity Score Matching Analysis. Braz J Cardiovasc Surg. 2019 Nov-Dec; 34(6): 653–658.