High prevalence of carotid artery disease in patients with atheromatous renal artery stenosis

Background. Renovascular disease is the most frequently encountered secondary cause of hypertension and is one of the few potentially reversible causes of chronic renal failure. These patients are at increased risk of having cerebrovascular events following operative management for atheromatous renal-artery stenosis. We studied the prevalence of carotid-artery disease in patients with atheromatous renal-artery stenosis. Methods. A cross-sectional study was carried out on 38 consecutive patients with atheromatous renal-artery stenosis who underwent renal-artery balloon angioplasty. Extracranial carotid atherosclerosis was assessed using a commercially available colour Doppler scanner, depending on the velocity of the peak systolic waveform in the internal carotid artery, and the internal carotid-artery/common carotid-artery ratio. Results. Twenty-one patients (55.3%) had normal or mild carotid-artery disease, 10 (26.3%) had moderate, and 7 (18.4%) had severe carotid-artery disease. Nine patients had previously suffered a stroke (eight infarction, one haemorrhage) and one had multiple transient ischaemic attacks. Conclusions. Our results suggest that, in patients with atheromatous renal-artery disease severe enough to require angioplasty, 4 out of 10 appear to have moderate to severe carotid-artery disease. This may explain the increased prevalence of atherothrombotic cerebrovascular events in these patients, and also previous observations that, following operative management for atheromatous renal-artery stenosis, some patients had developed an acute or late cerebrovascular event. We suggest therefore that such patients should always be regarded as having generalized vascular disease not confined to one system, and need to be assessed for carotid-artery disease prior to operative management for atheromatous renal-artery stenosis.