To investigate the prevalence and distribution characteristics of extracranial and intracranial atherosclerotic disease in high- risk patients with coronary heart disease (CHD).

Patients diagnosed with CHD by coronary angiography from March 2019 to February 2024 were retrospectively enrolled. Concurrent carotid ultrasonography and transcranial Doppler/color-coded sonography were performed. CHD was defined as ≥50% luminal stenosis in at least one major epicardial artery. Extracranial atherosclerotic disease (ECAD) was defined as ≥50% stenosis in any cervical artery on ultrasound, and intracranial atherosclerotic disease (ICAD) was defined as moderate-to-severe stenosis or occlusion in any major cerebral artery. CHD patients were stratified into non-high-risk (<3 risk factors, n=342) and high-risk groups (≥3 risk factors, n=720) based on the number of atherosclerotic risk factors. The prevalence and topographic patterns of multi-territorial atherosclerotic lesions were compared between the groups.

Among 1,062 CHD patients, the high-risk group had significantly higher prevalence rates of concurrent ECAD (31.9% vs 18.1%) and ICAD (26.3% vs 16.4%) (all P<0.001). High-risk patients showed a greater propensity for multi-vessel involvement across intracranial and extracranial territories, with the vertebral artery identified as the most commonly affected site.

High-risk CHD patients exhibit higher prevalence of coexisting ECAD and ICAD and more extensive multi-territorial atherosclerosis, particularly in posterior circulation. Targeted control of modifiable risk factors is warranted to mitigate long-term cerebrocardiovascular risks.