Multisite artery disease

Multisite artery disease (MSAD) is common in patients with atherosclerotic involvement in one vascular bed, ranging from 10-15% in patients with CAD to 60-70% in patients with severe carotid stenosis or LEAD. MSAD is invariably associated with worse clinical outcomes; however, screening for asymptomatic disease in additional vascular sites has not been proven to improve prognosis. In patients with any presentation of PADs, clinical assessment of symptoms and physical signs of other localizations and/or CAD is necessary, and in case of clinical suspicion, further tests may be planned. Systematic screening for asymptomatic MSAD is not indicated for any presentation of PADs as it would not consistently lead to a modification of management strategy. It may be interesting in some cases for risk stratification (e.g. antiplatelet therapy strategy beyond one year in patients who benefited from coronary stenting for ACS). In some situations the identification of asymptomatic lesions may affect patient management. This is the case for patients undergoing CABG, where ABI measurement may be considered especially when saphenous vein harvesting is planned, and carotid screening should be considered in a subset of patients at high risk of carotid artery disease. In patients scheduled for CABG with severe carotid stenoses, prophylactic carotid revascularization should be considered in recently symptomatic cases and may be considered in asymptomatic cases, after multidisciplinary discussion. In patients planned for carotid artery revascularization for asymptomatic stenosis, a preoperative coronary angiography for detection (and revascularization) of CAD may be considered.