Combined measurement of carotid stiffness and intima-media thickness improves prediction of complex aortic plaques in patients with ischemic stroke

• Published in: Stroke (1970) Vol. 37; no. 11; pp. 2708 - 2712
• Main Authors: HARLOFF, Andreas, STRECKER, Christoph, REINHARD, Matthias, KOLLUM, Marc, HANDKE, Michael, OLSCHEWSKI, Manfred, WEILLER, Cornelius, HETZEL, Andreas
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.11.2006
• Subjects: Adult; Aged; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Brain Ischemia - diagnostic imaging; Brain Ischemia - pathology; Cardiology. Vascular system; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Cohort Studies; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Predictive Value of Tests; Prospective Studies; Stroke - diagnostic imaging; Stroke - pathology; Tunica Intima - diagnostic imaging; Tunica Intima - pathology; Tunica Media - diagnostic imaging; Tunica Media - pathology; Ultrasonography; Vascular diseases and vascular malformations of the nervous system; Human; Cerebral infarction; Stroke; Nervous system diseases; aortic plaques; Echocardiography; Cardiovascular disease; carotid arteries; Cerebral disorder; Vascular disease; intima-media thickness; distensibility; Carotid; Central nervous system disease; Aorta; transesophageal echocardiography; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000244763.19013.dc

We hypothesized that for the prediction or exclusion of aortic thrombi or plaques >or=4 mm, the combination of intima-media thickness (IMT) and distensibility (DC) of the common carotid arteries would be superior to the measurement of IMT alone. We prospectively included 208 stroke patients (mean age, 60 years) undergoing transesophageal echocardiography for screening of aortic plaques. IMT and DC were determined by ultrasound, and DC was quantified by measuring blood pressure and the common carotid arteries diameter change on M-mode ultrasound during the cardiac cycle. Negative predictive values of IMT <0.9 mm and DC >or=24x10(-3)/kPa for the exclusion of aortic atheroma >or=4 mm were similar (92.0% and 91.7%, respectively). However, negative predictive values increased to 98.2% and to 100.0% for the exclusion of aortic thrombi when both parameters were combined. Positive predictive values of IMT >or=0.9 mm and DC <24 were lower (46.3%, 41.1%; respectively), but they also increased in combination (54.3%). Our findings suggest that IMT and DC represent different vessel wall properties and that measuring both parameters provides optimized characterization of carotid atherosclerosis. Combining IMT and DC increases the predictive power of carotid ultrasound, making transesophageal echocardiography dispensable for assessment of the aorta for those with normal carotid arteries and indispensable for those patients with carotid atherosclerosis.