Association of Carotid Artery Intima-Media Thickness with Complex Aortic Atherosclerosis in Patients with Recent Stroke

Fasseas, Panayotis; Brilakis, Emmanouil S.; Leybishkis, Biana; Cohen, Marc; Sokil, Alexis B.; Wolf, Nelson M.; Dorn, Rose Lee; Roberts, Andrew M.; VanDecker, William

doi:10.1177/000331970205300209

Cited by 20 publications

(12 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a previous study, we demonstrated that a normal carotid IMT excluded aortic high-risk sources of cerebral embolism, such as thrombi or plaques Ն4 mm, thus making transesophageal echocardiography (TEE) dispensable for assessment of the aorta. 6 However, in concordance with others, 7 positive predictive values were low.…”

supporting

confidence: 84%

See 1 more Smart Citation

Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke

Harloff

Strecker

Reinhard

et al. 2006

Stroke

View full text Add to dashboard Cite

Background and Purpose-We hypothesized that for the prediction or exclusion of aortic thrombi or plaques Ն4 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. Methods-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. Results-Negative predictive values of IMT Ͻ0.9 mm and DC Ն24ϫ10 Ϫ3 /kPa for the exclusion of aortic atheroma Ն4 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 Ն0.9 mm and DC Ͻ24 were lower (46.3%, 41.1%; respectively), but they also increased in combination (54.3%). Conclusions-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. (Stroke. 2006;37:2708-2712.)

show abstract

supporting

confidence: 84%

“…Cardiovascular risk factors were prospectively documented and defined as described previously. 7 Infarct etiology was classified according to the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria in each patient after completion of the diagnostic work-up. 9 …”

Section: Study Population and Cardiovascular Risk Factorsmentioning

confidence: 99%

Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke

Harloff

Strecker

Reinhard

et al. 2006

Stroke

View full text Add to dashboard Cite

show abstract

“…Though we did not directly visualize the atheromatous burden of the aortic arch, we assessed carotid IMT by means of ultrasound. An enlarged IMT independently predicts aortic plaques and complex aortic atherosclerosis [21,22]. In a previous study including patients from the present analysis, we found that aortic atherosclerosis alone does not account for the high risk from stenting in older patients, but that both age and aortic atherosclerosis independently predict periprocedural ischemic events [15].…”

Section: Discussionmentioning

confidence: 54%

Predictors of Periprocedural Brain Lesions Associated with Carotid Stenting

et al. 2011

View full text Add to dashboard Cite

Background: Carotid stenting carries a risk of periprocedural stroke. We aimed at determining predictors of cerebral ischemic events associated with stenting for symptomatic carotid stenosis. Methods: 127 patients who had been studied by diffusion-weighted MR imaging (DWI) before and on the day after carotid stenting were included. Six clinical variables and 5 variables characterizing the target carotid artery and aortic atherosclerosis were analyzed as potential risk factors for new ipsilateral DWI lesions after stenting. Results: Among all variables assessed, only age, length of stenosis and carotid intima-media thickness (IMT) significantly modified the risk of new lesions after stenting. Age ≧68 years, stenosis ≧15 mm and IMT ≧1.3 mm were identified as the best thresholds to predict new lesions. In the subgroup of patients ≧68 years with carotid stenosis ≧15 mm in length and IMT ≧1.3 mm, the risk of new lesions was markedly higher than in patients to whom no more than two of these factors applied (odds ratio 7.250, 95% CI 1.612–34.513, p = 0.005). The use of this simple predictive model correctly identified patients who had new lesions after stenting with high specificity (0.96) and a negative predictive value (0.83), while the positive predictive value was moderate (0.60) and sensitivity was low (0.23). Conclusions: The risk of stenting for symptomatic carotid stenosis may vary with clinical and morphological patient characteristics. Further research is needed to validate these results and to evaluate the safety of stenting versus endarterectomy in specific patient subgroups.

show abstract

“…Our findings are consistent with recent studies suggesting the use of CIMT testing for the exclusion of significant aortic atheroma. 8,9,17 In a prospective study, Harloff et al reported that use of CIMT testing achieved a negative predictive value of 92% for the detection of complex aortic atheroma. 9 Complex aortic plaques are particularly important to exclude because they are associated with a increased risk of recurrent stroke and may warrant therapy with statins or warfarin.…”

Section: Discussionmentioning

confidence: 99%

Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography

Ward

Lammertin

Virnich

et al. 2008

Stroke

View full text Add to dashboard Cite

Background and Purpose-Carotid intima-media thickness (CIMT) is associated with systemic atherosclerosis and cardioembolic conditions and predicts the risk of recurrent strokes. We sought to establish the relationship between CIMT and cardiovascular sources of embolus (CSE) on transesophageal echocardiography (TEE) and hypothesized that a noninvasive strategy of CIMT assessment and transthoracic echocardiography bubble study would identify patients with ischemic stroke or transient ischemic attack in whom TEE would provide little incremental diagnostic yield. Methods-In 180 patients with ischemic stroke or transient ischemic attack of undetermined origin referred for TEE, we prospectively performed CIMT measurement/plaque screen (Phase 1, nϭ96) or CIMT measurement/plaque screen and transthoracic echocardiography bubble study (Phase 2, nϭ84) before TEE. Phase 1 results were used to construct receiver operating characteristic curves to demonstrate the ability of CIMT to detect CSE on TEE and to identify the optimal CIMT cutoff value for prospective strategy testing (Phase 2). Results-In Phase 1, CIMT was found to correlate with TEE markers of aortic atherosclerosis, including complex aortic plaques, and combined CSE. The optimal CIMT cutoff for detection of CSE on TEE was 0.78 mm. In Phase 2, a positive noninvasive strategy test (CIMT Ն0.78 mm, ϩcarotid plaque, and/or a positive transthoracic echocardiography bubble study) was present in 61%. The prevalence of CSE on TEE was significantly higher among those with a positive compared with a negative noninvasive strategy test (65% versus 9%, PϽ0.001), and this strategy had a sensitivity of 92% and a negative predictive value of 91% for the detection of any CSE on TEE. Conclusion-In patients with stroke or transient ischemic attack of undetermined origin, a noninvasive strategy of CIMT assessment/plaque screen and transthoracic echocardiography bubble study can identify patients in whom further invasive evaluation with TEE will be of low diagnostic yield.

show abstract

Association of Carotid Artery Intima-Media Thickness with Complex Aortic Atherosclerosis in Patients with Recent Stroke

Cited by 20 publications

References 16 publications

Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke

Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke

Predictors of Periprocedural Brain Lesions Associated with Carotid Stenting

Use of Carotid Intima-Media Thickness to Identify Patients With Ischemic Stroke and Transient Ischemic Attack With Low Yield of Cardiovascular Sources of Embolus on Transesophageal Echocardiography

Contact Info

Product

Resources

About