Recurrent stroke: The role of common carotid artery intima-media thickness

Talelli, Penelope; Terzis, George; Katsoulas, Georgios; Chrisanthopoulou, Athina; Ellul, John

doi:10.1016/j.jocn.2006.06.019

Cited by 16 publications

(28 citation statements)

References 45 publications

(43 reference statements)

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“…CIMT testing is a noninvasive imaging modality that has been shown to correlate to systemic atherosclerosis, structural heart disease, and atrial fibrillation and predicts the risk of recurrent stroke. [1][2][3][4][5][6][7] The correlation between and CIMT and CSE on TEE among patients with ischemic stroke has not been reported. Furthermore, the ability of a noninvasive testing strategy incorporating TTE bubble study for detection of intra-atrial communications and CIMT for detection of other CSEs has not been investigated.…”

Section: Discussionmentioning

confidence: 98%

“…[1][2][3][4][5][6][7] Among patients with ischemic stroke, a low CIMT has been reported to have a high negative predictive value for the detection of complex aortic plaques, which are among the most prevalent CSE identified on TEE. 8 -13 Other evidence suggests that modern transthoracic echocardiography with bubble study is highly sensitive for the detection of intra-atrial communications, another commonly identified potential CSE after stroke.…”

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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: 98%

mentioning

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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“…20 A second study with a similar cohort (284 patients with a first-ever IS during a 1-year follow-up) showed that IMT adjusted for confounding factors was the only independent predictor of stroke recurrence (HR,1.65;95% CI,). 21 To the best of our knowledge, no previous studies have assessed the value of carotid IMT compared with SCS in predicting stroke recurrence. This is of potential interest not only because the data on the relationship between IMT and stroke recurrence are scarce but also because there is increasing evidence suggesting that IMT and plaques may be different phenotypes of the atherosclerotic process.…”

Section: Discussionmentioning

confidence: 99%

Value of Carotid Intima-Media Thickness and Significant Carotid Stenosis as Markers of Stroke Recurrence

Roquer¹,

Segura²,

Serena³

et al. 2011

Stroke

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on behalf of the ARTICO Study Background and Purpose-Data on the predictive value of carotid intima-media thickness (IMT) for stroke recurrence arescarce. We sought to analyze outcome differences in stroke patients with high IMT values compared with patients with significant carotid stenosis (SCS). Methods-The multicenter observational ARTICO study included 620 independent patients older than 60 years with a first-ever noncardioembolic stroke. Patients were followed-up for 1 year. The primary end point was a composite of cardiovascular events and death. The IMT-ARTICO substudy analyzed ultrasonographic data from 599 patients. After Doppler carotid echography, patients were classified into the SCS group (carotid stenosis Ն50%; 117 cases), high IMT group (patients with the common carotid IMT in the highest quartile Ն1.11 mm and without SCS; 110 cases), and control group (stroke patients with an IMT Ͻ1.11 mm and without SCS; 372 cases). We analyzed the impact of both conditions on the primary end point. Results-During follow-up, 88 patients (14.7%) had an end point event. Univariate analysis showed that male gender, diabetes, symptomatic peripheral arterial disease, ankle brachial index Յ0.9, SCS, and high IMT were related to the primary end point.

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“…17 IMT is correlated with systemic atherosclerosis and predicts the risk of recurrent strokes. [18][19][20] Recently published articles 21,22 suggested that MDCTA can evaluate the thickness of the carotid artery wall, referred to by Saba et al 21 as CAWT, and presented results indicating significant agreement between MDCTA and CD-US in the measurement of CAWT and IMT. 22 The purpose of this work was to investigate whether CAWT studied by using MDCTA is correlated with LA and its severity.…”

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confidence: 99%

Carotid Artery Wall Thickness and Leukoaraiosis: Preliminary Results Using Multidetector Row CT Angiography

Saba

Pascalis²,

Sanfilippo³

et al. 2011

AJNR Am J Neuroradiol

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Recurrent stroke: The role of common carotid artery intima-media thickness

Cited by 16 publications

References 45 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

Value of Carotid Intima-Media Thickness and Significant Carotid Stenosis as Markers of Stroke Recurrence

Carotid Artery Wall Thickness and Leukoaraiosis: Preliminary Results Using Multidetector Row CT Angiography

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