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It's time to think about the head and heart!
  1. P Bhogal1,
  2. S K Gill2,
  3. P A Brouwer1,
  4. H L D Makalanda3
  1. 1Department of Neuroradiology, The Karolinska Hospital, Stockholm, Sweden
  2. 2UCL National Hospital for Neurology and Neurosurgery—UCL Institute of Neurology, London, UK
  3. 3Department of Neuroradiology, The Royal London Hospital, London, UK
  1. Correspondence to Dr P Bhogal, Department of Neuroradiology, The Karolinska Hospital, Karolinskavagen Stockholm, Stockholm 17176, Sweden; bhogalweb{at}aol.com

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Introduction

In developed countries atherosclerotic cardiovascular and cerebrovascular events are the cause of death in almost 50% of people.1 The presence of disease in multiple vascular beds is associated with a greater risk of recurrent symptoms and complications. Hence, it is important to use all the tools at our disposal to appropriately identify those patients who are at risk. Prediction of coronary artery disease (CAD) traditionally uses age, sex, family history, smoking, serum cholesterol level, and blood pressure with risk assessment tools such as the Qrisk or Framingham risk score to predict the risk of myocardial infarction.2 ,3 There is increasing evidence to support the logical assumption that disease within the carotid arterial tree can predict disease at the coronary arterial vascular bed. In this article we discuss the understanding of these interlinked disease processes and the implications for us as both diagnostic and interventional neuroradiologists.

Concomitant coronary and carotid atherosclerosis

The prevalence of carotid artery stenosis (>50%) increases progressively among patients with non-obstructive CAD, single/double/triple vessel disease or disease affecting the left main coronary artery.4 Similarly, about 70% of patients with stroke but no previous coronary artery events were noted to have CAD, and just under one-third of those patients had severe (>50%) coronary stenosis.5 Furthermore, this study showed that patients with more than …

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