INTRODUCTION
Cardiovascular diseases (CVD) are the leading cause of death in Western
countries. Between 2005 and 2015, the number of deaths from CVD
increased by 12.5% worldwide. An estimated 17.9 million people died
from CVD, representing 32% of all global deaths. Of these deaths, 85%
were due to myocardial infarction and stroke 1, 2.
Atherosclerosis, as the main pathophysiological process of CVD, remains
the leading cause of morbidity and mortality in developed countries3 and can be detected even in young adults and
children 4. Coronary artery disease (CAD) and
peripheral artery disease (PAD) have a common underlying pathology of
atherosclerosis. The comorbidity of CAD and PAD has long been well-known5-20. The incidence of both significant and
non-significant atherosclerotic lesions in peripheral arteries in
patients with established CAD is presented in Figure 1. The risk factors
of both are well-defined. Risk factors (hypertension, diabetes, smoking,
hypercholesterolemia) with accompanying typical angina have
traditionally served as an indication for invasive coronary angiography
(CA). However, in daily clinical practice, many patients do not present
the typical syndrome of CAD. Thus the invasive diagnosis should be
preceded by a noninvasive test. Furthermore, patients without
electrocardiography findings and increased troponin levels may benefit
from non-invasive diagnostics.
In accordance with the recent guidelines established by the European
Society of Cardiology (ESC), following the exclusion of acute coronary
syndrome (ACS), diagnostic imaging modalities such as coronary computed
tomography angiography or single-photon emission computed tomography are
recommended 21. Despite many advantages, these
examinations have contraindications, are less available, and
cost-prohibitive (Table 1). Moreover, recent ESC guidelines indicate
solely carotid artery ultrasonography (CAUS) as a tool that should be
considered for detecting CAD plaque in suspected patients. A review of
current guidelines and promising approaches to atherosclerotic plaque
assessment is necessary to enhance the diagnosis, management, and
treatment of CAD in clinical practice.
The available, costless, safe, and sensitive tool in atherosclerosis
assessment is ultrasonography (US). Most studies investigated carotid
and femoral arteries, although their superficial location allows US
imaging with high resolution. Other vascular beds, such as the renal
arteries, abdominal aorta, and iliac arteries, may pose challenges to
accessibility. Despite some limitations is useful to detect high risk
patients given that the US become appropriable for risk stratification22.
In this review, we: i) underline coexisting PAD and CAD, ii) describe
the role of vascular US in CAD diagnosis, and iii) characterize the
usefulness of US in CVD risk assessment.