Coronary Artery Disease in Transient Ischemic Attacks, and Stroke Patients: Prevalence, Prognostic and Therapeutic Implications

pp 373-377

Abstract

After a transient ischemic attack or stroke the risk of myocardial infarction or sudden coronary death exceeds that of cerebrovascular recurrences. As coronary artery disease is often asymptomatic, a cardiologic evaluation is warranted in almost every patient with transient ischemic attacks or stroke. A non invasive screening protocol for coronary artery disease is based on exercise electrocardiographic testing and myocardial scintigraphy. In cerebrovascular patients unable to exercise, dipyridamole myocardial scintigraphy or echocardiography are safe and reliable alternative tests for coronary artery disease. Coronary angiography should be reserved for high risk patients, defined on the results of cardiologic non invasive investigation. Cerebrovascular patients with coexisting, even asymptomatic, coronary artery disease should be treated with coronary medications. In the individual patient, especially when carotid endarterectomy is planned, the indication to staged or combined coronary revascularization should be evaluated.