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Management of bilateral significant carotid artery stenosis in an asymptomatic patient with extensive coronary artery disease and significant risk factors Cover

Management of bilateral significant carotid artery stenosis in an asymptomatic patient with extensive coronary artery disease and significant risk factors

Romanian Journal of Cardiology
Volume 35 (2025): Issue 2 (June 2025)
By: Radu Adrian Suteu,  Diana-Andreea Moldovan,  Marian Pop,  Ioan Tilea,  Laurentiu Huma and  Andreea Varga  
Open Access
|Jun 2025

Figures & Tables

Figure 1

First diagnostic coronary angiogram (December 2020). Panel A: In LAO caudal view, an intermediate left main coronary artery stenosis, and significant lesions of LAD, LCx and OM are depicted. LAD - left anterior descending artery, LCx - left circumflex artery, LAO - left anterior oblique, LMCA - left main coronary artery, OM - obtuse marginal artery, PDA - posterior descending artery, RCA - right coronary artery.
First diagnostic coronary angiogram (December 2020). Panel A: In LAO caudal view, an intermediate left main coronary artery stenosis, and significant lesions of LAD, LCx and OM are depicted. LAD - left anterior descending artery, LCx - left circumflex artery, LAO - left anterior oblique, LMCA - left main coronary artery, OM - obtuse marginal artery, PDA - posterior descending artery, RCA - right coronary artery.

Figure 2

Staged percutaneous coronary interventions performed on LAD and LCx. Panel A: Angiographic results after stents implantation performed in December 2020 in proximal-mid segment and distal part of LAD (continuous arrows). The lesion in the mid-part of LAD (dotted arrow) was considered intermediate at that time (LAO cranial view). Panel B: The results of PCI completed in March 2021 with stent implantation in the OM (RAO caudal view). Panel C illustrate the progression of the lesion in the mid segment of LAD (arrow) and the angiographic finał result after stent implantation in March 2023 is outlined in panel D respectively (arrow). LAD - left anterior descending artery, LCx - left circumflex artery, LAO - left anterior oblique, LMCA - left main coronary artery, OM - obtuse marginal artery, PDA - posterior descending artery.
Staged percutaneous coronary interventions performed on LAD and LCx. Panel A: Angiographic results after stents implantation performed in December 2020 in proximal-mid segment and distal part of LAD (continuous arrows). The lesion in the mid-part of LAD (dotted arrow) was considered intermediate at that time (LAO cranial view). Panel B: The results of PCI completed in March 2021 with stent implantation in the OM (RAO caudal view). Panel C illustrate the progression of the lesion in the mid segment of LAD (arrow) and the angiographic finał result after stent implantation in March 2023 is outlined in panel D respectively (arrow). LAD - left anterior descending artery, LCx - left circumflex artery, LAO - left anterior oblique, LMCA - left main coronary artery, OM - obtuse marginal artery, PDA - posterior descending artery.

Figure 3

The global longitudinal strain of the left ventricle performed one year after the last PCI. The results are normal (-20.0%) in A4C view, and subtle disturbances in LAX view (- 16.9%), A2C view (-13.9%), but the mean value of -16.9% of GLS-LV are conclusive for altered longitudinal contraction of the myocardium. A2C - apical 2 chambers, A4C - apical 4 chambers, GLS-LS - global longitudinal strain of the left ventricle, LAX - long-axis, PCI - percutaneous coronary intervention.
The global longitudinal strain of the left ventricle performed one year after the last PCI. The results are normal (-20.0%) in A4C view, and subtle disturbances in LAX view (- 16.9%), A2C view (-13.9%), but the mean value of -16.9% of GLS-LV are conclusive for altered longitudinal contraction of the myocardium. A2C - apical 2 chambers, A4C - apical 4 chambers, GLS-LS - global longitudinal strain of the left ventricle, LAX - long-axis, PCI - percutaneous coronary intervention.

Figure 4

Three dimensional reconstruction of the supraortic arteries. Severe stenosis of bilateral ICA are depicted. No significant stenosis involving bilateral CCA, ECA, LSA and RSA were identified. ICA - intemal carotid artery, CCA - common carotid artery, ECA - extemal carotid artery, LSA - left subclavian artery, RSA - right subclavian artery.
Three dimensional reconstruction of the supraortic arteries. Severe stenosis of bilateral ICA are depicted. No significant stenosis involving bilateral CCA, ECA, LSA and RSA were identified. ICA - intemal carotid artery, CCA - common carotid artery, ECA - extemal carotid artery, LSA - left subclavian artery, RSA - right subclavian artery.

Figure 5

Three dimensional and sagittal multiplanar reconstructions confirmed the severity of left ICA (panel A) and right ICA respectively (panel B). ICA-internal carotid artery, CCA-common carotid artery, ECA-external carotid artery.
Three dimensional and sagittal multiplanar reconstructions confirmed the severity of left ICA (panel A) and right ICA respectively (panel B). ICA-internal carotid artery, CCA-common carotid artery, ECA-external carotid artery.
DOI: https://doi.org/10.2478/rjc-2025-0007 | Journal eISSN: 2734-6382 | Journal ISSN: 1220-658X
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Language: English
Page range: 152 - 158
Published on: Jun 30, 2025
Published by: Romanian Society of Cardiology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
atherosclerosis,
chronic coronary syndrome,
bilateral carotid artery stenosis,
carotid endarterectomy,
pharmacologic regimen
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Cardiology,
Surgery,
Cardiac surgery,
Pediatrics and juvenile medicine,
Paediatric cardiology

© 2025 Radu Adrian Suteu, Diana-Andreea Moldovan, Marian Pop, Ioan Tilea, Laurentiu Huma, Andreea Varga, published by Romanian Society of Cardiology
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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