Comparative study of carotid intima media thickness in ischemic stroke subtypes

Abstract

Ischemic stroke is a heterogeneous disease, with different subtypes, each of them presenting specific etiopathogenic aspects in which atherosclerosis and small vessel disease play a crucial role. Increased common carotid artery intima-media thickness (IMT) is a marker of atherosclerosis associated with ischemic stroke. Purpose. The aim of this study was to investigate if increased carotid IMT is related with certain ischemic stroke subtypes according to TOAST and Bamford/Oxfordshire criteria. Methods. In a prospective study 430 patients with ischemic stroke, classified in subtypes according to TOAST and Bamford/Oxfordshire criteria, were evaluated by cervical ultrasound. We measured carotid IMT bilaterally by B mode ultrasound aiming to fi nd a statistical correlation between carotid IMT and stroke subtypes. Results. All 430 patients with ischemic stroke (average age 64,67 years) were divided according to TOAST criteria as follows: 136 (31,63%) LAA, 48 (11,16%) CE, 107 (24,88%) SAA, 6 (1,4%) OE and 133 (30,93%) UE. In these patients mean ipsilateral carotid IMT varied as follows: 1,1426 mm for LAA, 1,0313 mm for CE, 1,0402 mm for SAA, 1,0167 mm for OE and 1,0647 mm for UE, with high statistical significance (p < 0,00001). According to Bamford/Oxfordshire classification the distribution of patients was as follows: 121 (28,14%) TACI, 199 (46,28%) PACI, 85 (19,77%) LACI and 25 (5,81%) POCI. In these patients mean ipsilateral carotid IMT varied as follows: 1,124 mm for TACI, 1,0955 mm for PACI, 1,0430 mm for LACI, 1,0776 mm for POCI with lower statistical significance (p <0,05). Conclusions. Highest carotid IMT value was found in LAA, respectively TACI stroke subtypes, and lowest value in SAA, respectively LACI subtypes. High carotid IMT, implicitly atherosclerosis, was better correlated with ischemic stroke due to large vessel disease and less correlated with small vessel disease.