J Clin Neurol.  2012 Jun;8(2):104-108.

Coexisting Carotid Atherosclerosis in Patients with Intracranial Small- or Large-Vessel Disease

Affiliations
  • 1Department of Neurology, The Catholic University of Korea College of Medicine, Yeouido St. Mary's Hospital, Seoul, Korea. ahyun@catholic.ac.kr

Abstract

BACKGROUND AND PURPOSE
The coexistence of carotid atherosclerosis in ischemic stroke patients with small-vessel disease (SVD) or intracranial large-vessel disease (ICLVD) was investigated using carotid duplex ultrasonography, and whether its coexistence affected the clinical prognosis was determined.
METHODS
Ischemic stroke patients with SVD or ICLVD were enrolled (n=103). Risk factors, demographic data, and National Institutes of Health Stroke Scale (NIHSS) scores were obtained for all of the subjects. Early neurological progression was defined by an increase in NIHSS score during the first 7 days. Carotid ultrasonography was performed to measure the intima-media thickness (IMT) and carotid plaques.
RESULTS
Among the 103 patients who were retrospectively enrolled in this study (56 with SVD and 47 with ICLVD), 66 (64.1%) had an atherosclerotic plaque and 23 (22.3%) had increased IMT. Increased IMT was observed more frequently in ICLVD than in SVD [15/47 (31.9%) vs. 8/56 (14.3%), p=0.032]. An atherosclerotic plaque was observed on subsequent carotid ultrasonographic examination in 28 (50%) of the 56 patients whose computed tomography angiography scans of the neck vessels were interpreted as normal. There was no association between presence of atherosclerotic change and early neurologic progression (p=0.94).
CONCLUSIONS
A coexisting atherosclerotic plaque or increased IMT was observed in 71.8% of patients with SVD or ICLVD. Whether the coexistence of carotid atherosclerotic change with either of these conditions affects the clinical prognosis remains to be elucidated.

Keyword

small-vessel disease; intracranial large-vessel disease; atherosclerosis; plaque; stroke

MeSH Terms

Angiography
Atherosclerosis
Carotid Artery Diseases
Humans
National Institutes of Health (U.S.)
Neck
Plaque, Atherosclerotic
Prognosis
Retrospective Studies
Risk Factors
Stroke

Figure

  • Fig. 1 Case 1: A 43-year-old male patient presented with lacunar infarction on the right basal ganglia (A). The carotid artery appeared to be patent on neck computed tomography (CT) angiography (B). However, ultrasonography revealed an increased intima-media thickness (IMT) and a focal plaque on the left common carotid artery (C). Case 2: A 54-year-old male patient with a left basal ganglia infarction had a focal atherosclerotic plaque on the left bulb (D and F), which was not detected on CT angiography (E). Case 3: A 58-year-old man with a right middle cerebral artery (MCA) territorial infarction from a right MCA stenosis appeared to have a patent carotid artery (G-I). However, a diffusely increased IMT was observed on ultrasonographic examination (J).


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