Management of bilateral significant carotid artery stenosis in an asymptomatic patient with extensive coronary artery disease and significant risk factors

Abstract Introduction Atherosclerosis is defined by the inflammatory process of the blood vessels driven by multiple cardiovascular risk factors. The involvement of at least two vascular territories significantly impacts prognosis and quality of life. Case Presentation Herein, we present the case of a middle-aged male patient, a former smoker, known with multiple cardiovascular risk factors: hypertension, uncontrolled type 2 diabetes mellitus, dyslipidemia, and history of multivessel coronary artery disease complex managed (subsequent serial percutaneous coronary interventions and optimal medical regimen). The patient was admitted for dyspnea on moderate exertion and mild vertigo. A resting electrocardiogram depicted sinus rhythm and sequelae of an inferior myocardial infarction. Advanced echocardiography revealed impaired myocardial contractility (hypo-contractility of the inferior wall). Carotid Doppler ultrasound examination reported bilateral sub-occlusive stenosis, later confirmed by computed tomography angiography. Afterward, a bilateral staged carotid endarterectomy, along with the best medical treatment, was provided. Conclusion In an asymptomatic patient with well-established cardiovascular risk factors and a documented history of severe coronary atherosclerosis, it is crucial to assess the extent of the atherosclerotic burden and implement appropriate medical management.