Coexisting carotid atherosclerosis in patients with intracranial small- or large-vessel disease
Ka Won Jung1, Young-Min Shon, Dong Won Yang
1Department of Neurology, The Catholic University of Korea College of Medicine, Yeouido St. Mary's Hospital, Seoul, Korea.
Insights
In ischemic stroke patients with small-vessel disease or intracranial large-vessel disease, carotid atherosclerosis was common. However, this coexistence did not appear to impact early neurological progression.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Ischemic stroke often involves multiple cerebrovascular pathologies.
- Understanding the interplay between small-vessel disease (SVD), intracranial large-vessel disease (ICLVD), and carotid atherosclerosis is crucial for comprehensive stroke management.
Purpose of the Study:
- To investigate the prevalence of carotid atherosclerosis in patients with SVD or ICLVD.
- To determine if coexisting carotid atherosclerosis influences early clinical prognosis in these patients.
Main Methods:
- Retrospective analysis of 103 ischemic stroke patients with SVD or ICLVD.
- Carotid duplex ultrasonography to assess intima-media thickness (IMT) and carotid plaques.
- Evaluation of early neurological progression using NIHSS scores within 7 days.
Main Results:
- Carotid atherosclerosis (plaque or increased IMT) was present in 71.8% of patients.
- Increased IMT was more frequent in the ICLVD group (31.9%) compared to the SVD group (14.3%).
- No significant association was found between the presence of atherosclerotic changes and early neurological progression (p=0.94).
Conclusions:
- A significant proportion of ischemic stroke patients with SVD or ICLVD also exhibit carotid atherosclerotic changes.
- The clinical impact of coexisting carotid atherosclerosis on early prognosis in this patient cohort requires further investigation.
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.
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