부산대학교 도서관

Objectives: The objectives of this cross-sectional study was to determine the prevalence of extra/-intracranial stenosis in patients with severe coronary artery disease (CAD) and to analyze how endothelial function and arterial stiffness are related to the presence of intracranial stenosis. Methods: We examined 57 patients with three vessels and/or left stem (LS) CAD. Brachiocephalic arteries were examined with extracranial and transcranial color-coded duplex sonography (ECCS, TCCS) and magnetic resonance angiography (MRA). Endothelial function was assessed as reactive hyperaemia index (RHI) by peripheral arterial tonometry (Endo-PAT). Carotid to femoral pulse wave velocity (cfPWV) and augmentation index (AIx@HR75) were assessed by applanation tonometry (Sphygmocor). Results: From 57 pts (age 65±9, 44–82; 33% female), 30 pts (53%) were diagnosed with three vessels disease, 27 pts (47%) with LS disease with/without three vessels damage (21 and 6). ECCS revealed carotid plaques and stenoses in 105/114 vessels (92%). TCCS revealed at least one intracranial stenosis in 61.4% pts (35/57). Patients with intracranial stenosis had significantly lower RHI (1.82±0.38 vs. 2.19±0.59, p=0.029) and higher AIx@HR75 (35.72±7.83% vs. 28.06±12.18%). However, there was no significant difference in cfPWV between the patients with and without intracranial stenosis (10.38±2.18 m/s vs 10.43±2.98 m/s, ns). Conclusions: Patients with severe CAD are at high risk to have a silent intracranial stenosis. In our study group, presence of intracrianal stenosis was associated with worse endothelial function but not higher arterial stiffness. Our finding suggests that in patients with generalized atherosclerosis endothelial dysfunction further contributes to the development of intracranial stenosis.