Carotid Atherosclerosis Does Not Predict Coronary, Vertebral, or Aortic Atherosclerosis in Patients With Acute Stroke Symptoms

Abstract

Background and Purpose— The purpose of this study was to determine whether significant atherosclerotic disease in the carotid arteries predicts significant atherosclerotic disease in the coronary arteries, vertebral arteries, or aorta in patients with symptoms of acute ischemic stroke. Methods— Atherosclerotic disease was imaged using CT angiography in a prospective study of 120 consecutive patients undergoing emergent CT evaluation for symptoms of stroke. Using a comprehensive CT angiography protocol that captured the carotid arteries, coronary arteries, vertebral arteries, and aorta, we evaluated these arteries for the presence and severity of atherosclerotic disease. Significant atherosclerotic disease was defined as >50% stenosis in the carotid, coronary, and vertebral arteries, or ≥4 mm thickness and encroaching in the aorta. Presence of any and significant atherosclerotic disease was compared in the different types of arteries assessed. Results— Of these 120 patients, 79 had CT angiography examinations of adequate image quality and were evaluated in this study. Of these 79 patients, 33 had significant atherosclerotic disease. In 26 of these 33 patients (79%), significant disease was isolated to 1 type of artery, most often to the coronary arteries (N=14; 54%). Nonsignificant atherosclerotic disease was more systemic and involved multiple arteries. Conclusions— Significant atherosclerotic disease in the carotid arteries does not predict significant atherosclerotic disease in the coronary arteries, vertebral arteries, or aorta in patients with symptoms of acute ischemic stroke. Significant atherosclerotic disease is most often isolated to 1 type of artery in these patients, whereas nonsignificant atherosclerotic disease tends to be more systemic.

Comprehensive Evaluation of Coronary Artery Disease and Aortic Atherosclerosis in Acute Ischemic Stroke Patients: Usefulness Based on Framingham Risk Score and Stroke Subtype

“…On the contrary, aortic atherosclerosis was more closely associated with the stroke subtypes large-artery atherosclerosis and small-artery occlusion than cryptogenic strokes in another study [11]. In a recent study, no association between carotid atherosclerosis and coronary, vertebral or aortic atherosclerosis was reported [37]. In our study, CAD (≥50% stenosis) was not associated with any specific stroke subtype; however, CAP was significantly associated with large-artery atherosclerosis and cardioembolism.…”

Validation of FDG Uptake in the Arterial Wall as an Imaging Biomarker of Atherosclerotic Plaques with 18F‐Fluorodeoxyglucose Positron Emission Tomography‐Computed Tomography (FDG‐PET/CT)

“…In agreement with our recent paper using CT, we showed that carotid atherosclerosis does not predict coronary, vertebral, or aortic atherosclerosis, and indeed significant atherosclerotic disease is more often isolated to one type of artery while nonsignificant atherosclerotic disease tends to be a systemic process . We also found that PET uptake is associated with presence of dyslipidemia, suggesting that PET uptake may be used as a hallmark of metabolic syndrome.…”

Multilevel Assessment of Atherosclerotic Extent Using a 40-Section Multidetector Scanner after Transient Ischemic Attack or Ischemic Stroke

“…The association between aortic and cervical atherosclerosis was not found by MDCT in this previous study (Adraktas et al) 13 but has been commonplace in studies using transesophageal echocardiography and carotid ultrasonography in patients with stroke. [14][15][16] A prospective study and a case-control study have shown that aortic plaques were more likely detected in patients with stroke with Ն50% carotid artery stenosis compared with Ͻ 50% carotid artery stenosis.…”

“…13 In this previous study, among 79 patients, 26 (33%) had 1 atherosclerotic level, mainly a Ն50% coronary artery stenosis. Only 7 patients (9%) had at least 2 atherosclerotic locations.…”