Diagnostic value of carotid intima-media thickness and clinical risk scores in determining etiology of ischemic stroke

Abstract

Background: In the general population, carotid intima-media thickness (CIMT) is associated with atherosclerosis as well as atrial fibrillation (AF). However, the extent to which CIMT might be of diagnostic value in clarifying stroke etiology is currently unclear. Methods: In this retrospective cohort study, we included 800 consecutive patients with acute ischemic stroke. We compared CIMT-values between stroke etiologies. The association between CIMT and cardioembolic stroke was investigated via logistic regression analysis adjusting for vascular risk factors. Receiver operating characteristic analyses were conducted to investigate the diagnostic value of CIMT in comparison to vascular risk factors and clinical AF risk scores (CHA2DS2VASc, HAVOC, and AS5F). Results: CIMT-values were highest in patients with cardioembolic or atherosclerotic stroke origin. CIMT was associated with newly diagnosed AF compared against cryptogenic strokes (crude odds ratio (OR) per 0.1 mm-increase of CIMT: 1.26 (95% confidence interval (CI): 1.13–1.41)). After adjustment for vascular risk factors, the effect of CIMT on AF-diagnosis, however, was weakened (adjusted OR: 1.10 (95% CI: 0.97–1.25)). The diagnostic value of CIMT for detection of AF (AUC: 0.60, 95% CI: 0.54–0.65) was outperformed by AF risk scores. Among the scores investigated, the AS5F-score yielded best accuracy and calibration to predict newly diagnosed AF (AUC: 0.71, 95% CI: 0.65–0.78). Conclusions: CIMT may help in the diagnosis of stroke etiology. However, compared with vascular risk factors or clinical AF risk scores, CIMT does not provide substantial additional information on the risk of newly detected AF. Thus, stratification of AF risk based on scores, such as the AS5F, is advisable.

Sex-Specific Risk Factors of Nonstenotic Carotid Plaque in Embolic Stroke of Unknown Source: A Case-Control Study

“…We included patients with an acute ischemic stroke (International Classification of Diseases, Tenth Revision: I63.0-9) with evidence by diffusion-weighted imaging in magnetic resonance imaging. For this analysis, an original cohort of 800 patients treated at the stroke unit of Hannover Medical School between January 2018 and July 2020 and reported previously 6 was restricted to those with ESUS (n=251), small-vessel disease (n=145) or cardioembolic stroke (n=213) because patients with large artery atherosclerosis reveal atherosclerotic disease as per definition, leaving 609 eligible cases. The presence of nsCP was evaluated by computed tomography angiography and duplex ultrasound according to the Mannheim Plaque Consensus criteria.…”