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

Abstract

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.

Different locations but common associations in subcortical hypodensities of presumed vascular origin: cross-sectional study on clinical and neurosonologic correlates

“…Our findings support this data particularly by the absent association with IMT. The quantification of the intima-media layer in the carotid artery [34] is one of the most commonly used surrogate markers of atherosclerosis and has been shown to predict future clinical atherosclerotic complications both cerebrovascular and coronary [18,35]. Our study did not show an independent association of IMT with SHPVO, once again corroborating a lack of causality of extracranial atherosclerosis with SHPVO.…”

A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease

“…29 Ward et al 30 showed that an increase in CIMT by 0.80 mm correlated with an enhanced risk of carotid atherosclerosis. We found that 11.7% of our study subjects had CIMT value more than 0.80 mm and 9.9% showed plaques.…”

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

“…[14][15][16] One of the most commonly used parameters for evaluating carotid atherosclerosis by using US is the IMT, which represents the quantification of the intima-media layers of the carotid artery. 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.…”