Abstract
B- mode ultrasound is a non-invasive method of examining the wall of the peripheral arteries And provides measures of the intima – media thickness (IMT) at various sites (common carotid artery, internal carotid artery), and plaques that may indicate early pre symptomatic diseases; therefore, estimating the intima-media thickness and plaque is important in term of evaluating patients with higher risk of cardiovascular and cerebrovascular disease.
Objectives: We investigated whether carotid intima-media thickness and plaque measured by noninvasive B-mode Ultrasonography predicts ischemic stroke.
Methods and Patients: This is a case - control study of patients admitted to hospital with diagnosis of ischemic CVA ; and patients without ischemic infarction; the diagnosis of cerebral infarction was confirmed by new CT of the brain. All participants underwent the standard examination and testing as well as carotid B-Mode ultrasound (Ultrasound measurements of right and left common carotid artery IMT and internal carotid artery IMT were made) and arteries were examined for plaques 1.5 cm a above and below the flow divider.
Result: 52 patients were included in the study, 26 patients with ischemic stroke(case subjects) and 26 patients (control subjects).Mean maximum common carotid artery IMT , internal carotid artery IMT and the prevalence of plaque were significant higher in CVA group ( P < 0.05 , p= 0,001 , p <0.001 , respectively), other risk factors showed no significant difference between groups.
Conclusion: The present study demonstrated increased maximum IMT of the common carotid artery, internal carotid artery. And Plaque in ICA are strong predictors for ischemic stroke.
Key word: Stroke, Intima - media thickness (IMT), Ultrasonography, Plaque, Common carotid artery (CCA) , Internal carotid artery (ICA).
References
1. Akihiko K . Hiroyasu I, Hironori I, Tetsuya O, Takeo Ok , Shinichi S et al. Carotid Intima- media thickness and plaque characteristics as a Risk factor for stroke in Japanese Elderly men. Stroke. 2004:35:2788-2794.
2. Belcaro G, Nicolaids AN ,Laurora G , Cesarone MR, De Sanctis M, imcan-delab Barsotti A . Ultrasound morphol-ogy calcification of the arterial wall and cardiovascular events in a 6-year follow-up study. Arterioscler thromb vas Bio/ 1996;16:851-856.
3. Bots ML, Van Meurs JCHM ,Grobbe DE. Assessment of early atheroscl-erosis: a new perspective. J Drug Res. 1991;16:150-154.
4. Bots ML ,Witteman JCM ,Grobbe DE. Carotid intima-media wall thickness in elderly women with and without atherosclerosis of the abdominal aorta. Atherosclerosis. 1993;102:99-105.
5. Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, Rosaamond W, Crow RS, Rautaharju PM, Heiss G, for the ARIC study group. Arterial wall thickness is associated with prevalent cardiovascular disease in middle age adults: the atherosclerosis Risk in Communities (ARIC) study. Stroke. 1995;26:386-391.
6. Crouse JR III , Byington RP, Bond MG, Espland MA, Craven TE, Sprinkle JW, McGovern ME, Furberg CD .Pravastatin, lipids, and atherosclerosis in the carotid arteries (PLAC-II). Am J Cardiol .1995;75:455-459.
7. Holander M, Bots ML, Delsol AL, KoudstaaL PJ Wittemen JCM, Grobbe DE, Hofman A, Breteler MB: Carotid plaque increase the risk of stroke and subtypes of Cerebral infarction in asymptomatic elderly: Rotterdam study Circulation. 2002;105:2872-287.
8. Hunt Kj, Evans GW, Folsom AR, Sharrett AR , Chambless LE, Tegeler CH, Heiss G . Acoustic shadowing on B-mode ultrasound of carotid artery predict ischemic stroke: the atherosclerosis risk in Communities (ARIC) study. Stroke2001;32:1120-1126.
9. Manolio TA, Burke GL, Oleary DH, Evans G, Beauchamp N, Knepper L, Ward B . Relationship of cerebral MRI finding to ultrasound atherosclerosis in older adults: The Cardiovascular health study. CHS . Collaborative Research Group. Arterioscler Thromb vas Biol, 1999;19:356-365.
10. O Leary DH, Polak JF, Wolfson SK, Bond MG, Bommer W, Sheth S, Psaty BM, Sharett AR, Monolio TA, on behalf of the CHS Collaborative Group. Use of Ultrasonography to evaluate carotid atherosclerosis in the elderly: the Cardiovascular Health study. Stroke; 22:1155-1163.
11. Pierre JT, Alexis EL , Cornelia KO, Christian LU, Valerie AD, Common carotid artery intima-media thickness and brain infarction; Circulation .2000; 102:313-318.
12. Polak JF, Shemanski L, Oleary DH, Lefkowitz D, Price TR, Savage PJ, Brant WE, Reid C. Hypo echoic Plaque at Ultrasound of the carotid artery: an independent risk factor for incident stroke in adults aged 65 year or older . Cardiovascular health study. Radiology. 1998;208:649-654.
13. Salonen R, Salonen JT. Determinants of carotid intima-media thickness :a population –based ultrasonography study in eastern Finnish men. J Intern Med 1991;229:225-231.
14. Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circula-tion .1993;87(supple II): II-56-II-65.
15. Shah EB, Olia PA, Peter WH, Goya WA, Mary WA, MPHM (Hon); Andrew N. Nicolaides, Surinder DH, et al. Carotid plaque , Intima Media Thickness , Cardiovascular Risk Factor , and Prevalent cardiovascular disease in men and women .Stroke 1999;30:841-850.
16. Veller MG, Fisher CM, Nicolaides AN. Measurement of the Ultrasonic intima-media complex thickness in normal subjects. J vas Surg. 1993;17:719-725.