SummaryStrokes are a major public health problem where carotid artery stenosis accounts for 20 to 30% of all cases. Also, patients with concomitant critical carotid and coronary artery disease are at risk of major neurological events specially during coronary artery bypass grafting.Cardiologists often underestimate the prevalence of renal artery stenosis in their cardiac patients, and there are no specific guidelines that address the timing or indications to perform renal angiography in patients undergoing coronary angiography.To evaluate the prevalence of carotid and renal artery stenosis in patients with documented coronary artery disease and the role of predisposing risk factors for such affection in Egyptian patients, we prospectively studied 100 patients. Who were subjected to coronary angiography and were with significant stenosis (> 70% stenosis) of at least one vessel, and/or > 50% in the left main coronary artery.In the same setting, these patients were subjected to both carotid and renal angiography, either selective or nonselective. Where significant carotid or renal artery stenosis was considered if stenosis > 50%.Risk factors for atherosclerosis were evaluated for all our patients including, patients age, gender, smoking history, hypertension, diabetes mellitus and dyslipidemia. Also, renal function tests (blood urea and serum creatinine) were evaluated.All patients were classified into three groups according to the presence or absence of significant carotid and renal artery stenosis:Group I: Patients with positive coronary artery disease and normal carotid and renal arteries bilateral.Group II: Patients with positive coronary artery disease and with either significant carotid artery stenosis [group IIa], or with significant renal artery stenosis [group IIb].Group III: Patient with positive coronary artery disease and with significant both carotid and renal artery stenosis.Carotid artery stenosis:The prevalence of significant carotid artery stenosis with significant coronary artery disease was found to be 17%. Patients in group IIa were significantly older comparing with group I (t = 4.79 and p = 0.001) and there was a significant positive correlation between the age of the patients and the presence of carotid artery stenosis (r = 0.32 and p = 0.001).The presence of hypertension in carotid artery stenosis group among studied patients was found to be significant ( OR = 5.76 and 95 % CI = 1.38 – 27.70).There was a significant relation between dyslipidemia and the presence of carotid artery stenosis (P = 0.004), where total serum cholesterol and low density lipoprotein levels were significantly higher in group IIa (t = 3.66, P = 0.001, and t = 3.65, p = 0.001, respectively).There was positive correlation between the level of total serum cholesterol and low density lipoprotein, and the affection of carotid artery (r =0.316, p = 0.001 and r = 0.307, p = 0.002 respectively).There was a significant increase in the incidence of carotid artery disease with increase in the number of coronaries affected (x2 = 11.475 and p = 0.001), and this showed a positive correlation between the number of stenosed coronary arteries and the presence of carotid artery stenosis (r = 0.361 and p = 0.001).The two groups did not differ with respect to gender, diabetes mellitus and smoking.The multivariate predictors of carotid artery stenosis was the number of coronaries affected, while in the multiple logistic regression analysis we found that, both dyslipidemia and the number of coronary arteries affected were considered significant predictors of carotid artery stenosis.Renal artery stenosis:The prevalence of significant renal artery stenosis with significant coronary artery disease was found to be 7%.Serum concentrations of urea and creatinine were significantly higher in group IIb (t = 7.83 ,P = 0.001and t = 6.83 and P = 0.001, respectively). There was a positive correlation between the level of both urea and creatinine and the increased incidence of renal artery stenosis in coronary artery diseased patients (r = 0.391, p = 0.001 and r = 0.415, p = 0.001 respectively).There was a significant relation between dyslipidemia and the presence of renal artery stenosis (P = 0.043). Total serum cholesterol and low density lipoprotein levels were significantly higher in this group of patients (t = 4.23, P = 0.001, and, t = 1.95, p = 0.05, respectively).There were a significant relation between hypertension and the presence of renal artery stenosis (P = 0.014).There was a significant increase in the incidence of renal artery stenosis with increase in the number of coronaries affected (p = 0.046).The two groups did not differ with respect to age, gender, diabetes mellitus and smoking.The multivariate predictors of significant renal artery stenosis was the elevated level of blood urea and serum creatinine.ConclusionCoronary artery disease is not uncommonly associated with carotid and renal artery stenosis.The prevalence of significant carotid artery stenosis with significant coronary artery disease was found to be 17%.The prevalence of significant renal artery stenosis with significant coronary artery disease was found to be 7%.Carotid artery disease is more common in patients with old age, hypertension, dyslipidemia and with more than two vessel diseased coronaries.Renal artery disease is more common in hypertensive patients with elevation of blood urea and serum creatinine levels, dyslipidemic and with more than two vessel diseased coronaries.Complications of carotid and renal angiography are not common and transient, the overall complication rate was 7%. This make carotid and renal angiography a safe diagnostic tool.RecommendationsScreening for extracranial carotid artery disease must be taken into consideration while treating patients with significant coronary artery disease, especially with more than two vessel disease. Particularly if the patient is hypertensive, dyslipidemic and with old age.Also, screening for renal artery disease must be taken into consideration while coronary angiography was done especially when the patient is hypertensive and with elevated level of both blood urea and serum creatinine, dyslipidemic and with multivessel coronary artery disease.