Association between calcification of the cervical carotid artery bifurcation and white matter ischemia
N F Fanning1, T D Walters, A J Fox
1Division of Neuroradiology, Department of Medical Imaging, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Insights
Carotid calcification does not independently predict future stroke risk, as measured by white matter changes on CT scans. Age, not calcification, is the primary factor influencing both conditions.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Cervical carotid artery calcification's link to future stroke risk is unknown.
- Coronary artery calcification predicts heart disease risk.
- White matter change severity correlates with future stroke risk.
Purpose of the Study:
- Assess if carotid calcification predicts stroke risk using white matter severity.
- Correlate white matter changes and stroke risk with carotid calcification grade.
Main Methods:
- Retrospective review of 209 unenhanced neck and brain CTs.
- Quantified carotid calcification using the Agatston method.
- Scored white matter changes using the European Task Force scale, blinded to other variables.
Main Results:
- Both carotid calcification and white matter scores strongly correlated with age.
- No independent association between carotid calcification and white matter scores after adjusting for age.
- Men showed slightly higher calcified carotid plaque load than women, controlling for age.
Conclusions:
- Carotid calcification scores do not independently predict white matter ischemia severity.
- Carotid calcium scores cannot predict future stroke risk assessed by white matter severity.
Background And Purpose:
The association of cervical carotid artery bifurcation calcification to future stroke risk is unknown, though coronary artery calcification is a proven indicator of heart disease risk. Severity of white matter change has been correlated with future stroke risk. We sought to use white matter severity grade on CT as a surrogate predictor of relative future stroke risk and thus correlate white matter and future stroke risk with carotid calcification grade.
Methods:
We retrospectively reviewed unenhanced neck and brain CTs in 209 patients. Carotid calcification degree was scored by the Agatston method, adapted from that commonly used to quantify coronary artery calcification. White matter change severity was scored by the European Task Force for Age-Related White Matter Change scale. Both scores were measured blinded to each other, and to age and sex covariables. Association was tested by univariate and multivariate analyses.
Results:
Both carotid calcification and white matter scores were strongly, and independently, associated with increasing age (r = 0.61, P < .001; and r = 0.67, P < .001, respectively). Despite apparent association between carotid calcification and white matter scores on univariate analysis, there was no independent effect evident after adjusting for age as a covariant (r = 0.07, P = .14). Sex had no independent effect on white matter scores, though men had a marginally higher mean calcified carotid plaque load than women after controlling for age (P = .008).
Conclusions:
Carotid calcification scores do not independently predict severity of white matter ischemia. Future stroke risk, assessed by white matter severity scores, cannot be predicted from carotid calcium scores.
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