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

Harloff, Andreas; Strecker, Christoph; Reinhard, Matthias; Kollum, Marc; Handke, Michael; Olschewski, Manfred; Weiller, Cornelius; Hetzel, Andreas

doi:10.1161/01.str.0000244763.19013.dc

Cited by 45 publications

(48 citation statements)

References 19 publications

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“…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%

“…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. 18 -21 Additionally, we have previously reported that complex aortic plaques are the only individual CSE found on TEE after ischemic stroke to be associated with an increased mortality.…”

Section: Discussionmentioning

confidence: 99%

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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

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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.

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Section: Discussionmentioning

confidence: 99%

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

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“…The presence of PAD may indicate the terminal stage of systemic atherosclerosis. [27][28][29] On multivariate logistic regression analysis, the independent factors associated with ACL were age, smoking and the presence of PAD. Age and smoking were earlier reported to be risk factors for ACL.…”

Section: Discussionmentioning

confidence: 99%

Predictors of aortic complicated lesions in stroke patients

et al. 2009

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Aortic complicated lesions (ACLs) should be associated with cerebral infarction. Our aim was to develop a simple clinical scale (ACL scale) to predict the presence of ACL. Consecutive stroke patients undergoing transesophageal echocardiogram (TEE) examination were prospectively enrolled. We defined ACL as the presence of 44 mm wall thickness, ulceration or mobile plaque in aortic arch. We also examined carotid intima-media thickness (IMT), ankle-brachial index (ABI) and brachial-ankle pulse-wave velocity (baPWV). We compared the clinical characteristics of patients with ACL (ACL group) and without ACL (non-ACL group), and devised a new ACL scale to predict the presence of ACL. In all, 165 patients (male 108, age 66.9 years) were enrolled and of these, 38% had ACL. The patients of the ACL group were older than those of the non-ACL group (73.0±10.2 vs. 63.1±13.6 years, P¼0.001). Peripheral artery disease (PAD) was more frequent in the ACL group (18 vs. 4%, P¼0.004). IMT was thicker in ACL group than in the non-ACL group (1.29 ± 0.74 vs. 1.11 ± 0.79 mm, P¼0.002), and baPWV was higher in the ACL group (2164.2 ± 643.2 vs. 1833.7 ± 492.9 cm s À1 , P¼0.001). We used three variables for determining the ACL scale score; (1) age 470, (2) presence of PAD and (3) smoking. The frequencies of ACL associated with ACL scale scores were as follows: 6% of patients with ACL scale score 0, 40% with score 1, 58% with score 2 and 100% with score 3. The ACL scale can predict the presence of aortic complicated lesions.

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“…A minimum of 4 measurements of the common carotid far wall were taken 10 mm proximal to the bifurcation to derive mean carotid intima-media thickness (IMT) [13]. We considered carotid IMT to be normal when IMT was ≤0.9 mm and increased when IMT was >0.9 mm [14]. Carotid artery plaque was assessed according to standard scanning and reading protocols [15].…”

Section: Methodsmentioning

confidence: 99%

Impaired Brachial Flow-Mediated Dilation Is a Predictor of a New-Onset Vascular Event after Stroke

Santos‐García¹,

Blanco²,

Serena³

et al. 2011

Cerebrovasc Dis

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Background and Objective: Brachial arterial flow-mediated dilation (FMD) is associated with an increased risk of vascular events. Our aim was to investigate the relationship between FMD measured in the acute phase of ischemic stroke and a new major adverse vascular event in a consecutive cohort of patients followed up for 48 months after an acute first-ever stroke. Methods: We measured FMD in 120 consecutive patients with acute ischemic stroke using high-resolution ultrasonography. FMD was calculated as the relationship between the basal diameter of the brachial artery before and after transient vascular occlusion. Intima-media thickness, extracranial carotid atherosclerosis, stroke severity National Institute of Health Stroke Scale, and modified Rankin Scale at 3 months were also evaluated. A vascular event was defined as any of the following: vascular disease (VD) death, nonfatal myocardial infarction (MI), nonfatal recurrent stroke (RS), claudication or peripheral arterial thrombosis (PVD), angioplasty or cardiac bypass graft surgery. Results: There were 34 new major adverse vascular events in 32 of 120 patients (26.7%): 21 (61.8%) RS, 5 (14.7%) VD death, 5 (14.7%) MI, and 3 (8.8%) PVD. The presence of carotid artery plaque (81.3 vs. 46%; p < 0.0001), atrial fibrillation (37.5 vs. 14.8%; p = 0.007) and FMD (5.30 ± 7.48 vs. 10.54 ± 7.02; p = 0.001) were associated with new-onset vascular events. FMD ≤4.5% was an independent predictor of new-onset vascular events (hazards ratio 3.48; 95% confidence interval 1.26–9.63; p = 0.01). Conclusions: FMD is an independent predictor for a new-onset vascular event after first-ever ischemic stroke.

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

Cited by 45 publications

References 19 publications

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

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

Predictors of aortic complicated lesions in stroke patients

Impaired Brachial Flow-Mediated Dilation Is a Predictor of a New-Onset Vascular Event after Stroke

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