XVII. European Stroke Conference
Nice, France

Poster Session: IMT
 

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Common carotid intima media thickness is a marker of clinical severity in patients with acute symptomatic carotid artery stenosis.
I. Heliopoulos    M. Papaioakim    G. Tsivgoulis     T. Hatzidounas     K. Vadikolias    N. Papanas     C. Piperidou                     
 
Democritus University of Thrace, Alexandroupolis

GREECE

Background: Increased common carotid artery intima-media thickness (CCA-IMT) is a risk factor for ischemic stroke and especially large vessel atherothrombotic infarction. However, little data are available regarding the potential association of stroke severity with the intima-media thickening. We sought to investigate the association between CCA-IMT and clinical severity of ischemic stroke in patients with symptomatic carotid artery stenosis (SCAS). Methods: Consecutive patients with acute, first-ever ischemic stroke and SCAS (50%-99%) were prospectively evaluated. All subjects underwent IMT measurements at the far wall of CCA by two experienced sonographers blinded to patient clinical data. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS) on hospital admission and Barthel Ambulatory Index (BI) at hospital discharge. Statistical analyses were performed using Spearman’s correlation coefficient (r) and multivariate linear regression models. Results: The intra- and inter-observer reliability for CCA-IMT measurements were acceptable with an intra-class correlation coefficient of 0.923 (95% CI: 0.810-0.968) and inter-class correlation coefficient of 0.932 for observer 1 and 0.902 for observer 2. CCA-IMT was strongly correlated to NIH (r=0.546, p<0.001) and BI (r=-0.450, p <0.001) in the study population (n=102). A 0.1mm increase in CCA-IMT was independently associated with a 5-point increment in NIHSS on hospital admission (95%CI: 3-7; p<0.001) and a 6-point decrement in BI at hospital discharge (95%CI: 3-9; p<0.001) even after adjustment for baseline characteristics and stroke risk factors. Discussion: Increased CCA-IMT is independently associated with more severe stroke on admission and poorer functional outcome at hospital discharge in patients with SCAS. The addition of CCA-IMT measurement to the risk stratification of patients with SCAS may prove valuable in the identification of individuals who are at risk for severe stroke.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Measurement of common carotid artery intima-media thickness in clinical practice: comparison of B-mode versus RF-based technique.
F.H.Schreuder    I.M.Graf    J.M.Hameleers     W.H.Mess     A.P.Hoeks                                    
 
Department of Clinical Neurophysiology, University Hospital Maastricht

THE NETHERLANDS

Background: Common carotid artery intima-media thickness (CCA-IMT) is widely used in observational and interventional studies. CCA-IMT is most commonly measured in B-mode ultrasound images by manual or automatic detection of the double-line pattern on the posterior arterial wall. A different approach to measure CCA-IMT is the use of radio frequency (RF) multiple M-line analysis. The present study explores the relation between B-mode and RF measurement of CCA-IMT in subjects with cardiovascular diseases. Methods: The study cohort is composed of 174 consecutive patients with recently diagnosed cardiovascular disease. Within one session, double measurements were made in the distal CCA bilaterally, using both the B-mode as well as RF technique. To explore the level of correlation between the two measurements, Pearson correlation coefficient (r) is calculated. Mean difference and 95% confidence intervals (CI) is examined using Bland-Altman plot and tested for significance using a paired t-test. Results: B-mode and RF measured CCA-IMT were 0.788 +/- 0.208 mm and 0.712 +/- 0.195 mm, respectively. The two methods correlate well (r = 0.738). B-mode CCA-IMT is significantly larger than RF CCA-IMT (mean difference of 0.076 mm; 95%-CI: - 0.216 mm to 0.368 mm; t = 9.67; p < 0.001). Intrapatient variation for B-mode and RF-based CCA-IMT are comparable (0.06 +/- 0.07 mm and 0.07 +/- 0.09 mm, respectively). Discussion: RF measured CCA-IMT correlates well with B-mode measurement of CCA-IMT, but results in a significantly smaller value for CCA-IMT. Both methods have similar reproducibility. Hence, the RF-based technique can be used to determine CCA-IMT. A main advantage of the technique is the possibility to derive dynamic vessel wall parameter (e.g. distension, compliance) simultaneously.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Carotid intima-media thickness and pro-inflammatory biomarkers such as RAGE, RANTES, IL-6, Amyloid A, CD40, adiponectin, and haptoglobin
M.H.Park    H.Y.Park    N.H.Kim     J.A.Seo     B.K.Kim    C. Han     S.A.Jo     I. Jo             
 
Korea University College of Medicine

SOUTH KOREA

Background: Recent investigations of atherosclerosis have focused on inflammation, providing new insight into mechanisms of disease. Carotid artery atherosclerosis was known to represent risk factors of cerebrovascular disease. Cerebrovascular disease is associatied with a prothrombotic and the proinflammatory state. However, the relationship of inflammatory biomarkers to carotid IMT is not clear. OBJECTIVE: To study the association between a group of thrombotic and inflammatory biomarkers and the carotid IMT. Methods: Carotid IMT was measured (B-mode ultrasound) in 368 subjects from the population-based elderly Korean cohort study. The expression of the receptor for AGEs (RAGE), regulated upon activation, normal T-cell expressed and secreted (RANTES), serum Amyloid A (SAA), interleukin-6 (IL-6), soluble CD40 ligand, adiponectin, and haptoglobin were assessed cross-sectionally. RESULTS: Common carotid artery far-wall IMT was associated with brachial-ankle pulsewave velocity (r=0.170, p<0.001) and serum homocysteine level (r=0.166, P<0.001). Carotid IMT was associated with a higher IL-6 level (r=0.153, p<0.001). However, these carotid IMT was not significantly associated with other proinflammatory biomarkers such as RAGE, RANTES, SAA, soluble CD40 ligand, adiponectin, and haptoglobin (all p>0.05). Some conventional quantitative risk factors were utilized to perform multivariate factor analysis. Individual inclusion, in this analysis of each biomarker, showed that, only IL-6 was the most important biomarkers that clustered with increased carotid IMT factor. The other biomarkers were not informative. Conclusion: IL-6 is an important biomarker for carotid IMT. Our study suggests that in patients with pre-atherosclerotic disease, it is useful to screen the peripheral circulation by non-invasive tests, such as inflammatory biomarker as well as carotid IMT.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
CAROTID INTIMA-MEDIA THICKNESS IS ASSOCIATED WITH INTRACRANIAL FLOW RESISTANCE
T. SEGURA    J. GARCIA-GARCIA    O. AYO     G. VEGA     M.D.ZORITA                                    
 
HOSPITAL DE ALBACETE

SPAIN

Background and purpose: Although carotid intima-media thickness (IMT) is widely used to study presence and progression of atherosclerosis, some authors have argued that this parameter may reflect an adaptative response of the vessel wall to tensile stress. If the latter is true we hypothesize that it should be a correlation between carotid IMT and distal resistance to flow, estimated by means of intracranial pulsatility index (PI). Methods: During last year we systematically evaluated ultrasonographyly carotid and intracranial blood flow in every patient referred to our neurovascular laboratory. We assessed common carotid IMT, velocity and PI of intracranial arteries, presence and type of atheroma plaques and atherosclerosis risk factors (ARF) in all patients. We excluded of the study those patients with hemodynamically significant (> 50%) carotid or intracranial stenosis given that this circumstance changes PI values. We evaluated the relationship between demographics, atherosclerosis risk factors and pulsatility index of the middle cerebral artery with carotid IMT. Results: 434 patients were included. 58.5% were men. Mean age, 66 (19-87), 15% were smokers, 71% hypertensives, 28% diabetics, 44% dyslipemics. IMT was 0.93 +/- 0.24, PI 1.00 +/- 0.24. All ARF except smoking were significantly associated with IMT thickening . There were no significant gender differences in IMT values. Carotid IMT values correlated highly with age and PI. After adjustment for all ARF and demographics in a multivariate model only PI kept significant association with IMT Discussion: Our results suggest that common carotid IMT thickening may be an adaptative response to resistance to flow instead of an atherosclerotic marker.

Session: Poster Session I
Date: Wednesday 14 May 2008  
Time: 12:30 - 14:00
Room: Agora 2

  
Structural and functional characteristics of the common carotid artery in young adults with type 1 diabetes
I. Vastagh    T. Horváth    G. Nagy     T. Varga     M. Kollai    D. Bereczki     A. Somogyi                     
 
Semmelweis University Faculty of Medicine

HUNGARY

Background: Type 1 diabetes mellitus is an important risk factor for microvascular disease, and large vessel dysfunction. We evaluated the early signs of carotid atherosclerosis in type 1 diabetes. We examined the structural and functional characteristics of large arteries. Methods: A pilot study was performed in 25 patients with type 1 diabetes and 10 controls. We investigated the carotid intima-media thickness (IMT), compliance (cc), distensibility (dc), circumferential strain (str), intima-media cross section area (IMCSA), stiffness index (SI), incremental elastic modulus (Einc) and carotid-femoral pulse wave velocity (PWV). Carotid was measured with ultraconographic vessel wall-movement tracking device. Carotid pressures and PWV were determined with applanation tonometry. Brachial blood pressure (BP), anthropometric and metabolic parameters (serum lipids, plasma glycated haemoglobin and C-reactive protein) were measured. Results: The diabetic group showed significantly lower dc than the controls (3.9 +/-1.3 vs 5 +/-1.7 10-3/Hgmm, p<0.05). The str (8.6 +/-1.8 vs 10 +/-1.7 %, p=0.059) and cc (12.7 +/-3.9 vs 16 +/-5.3 cm/Hgmm, p=0.055) were lower than in controls. The IMT was thicker, the other parameters (IMCSA, SI, Einc, PWV) were higher in the diabetic group, but the difference has not reached statistical significance. The diabetic patients had significantly higher values of BP (mean: 95 +/-8 vs 82 +/-14 Hgmm, p<0.05) and serum cholesterol (4.8 +/-0.8 vs 4 +/-0.5 mmol/l, p<0.05). Conclusion: Our results are preliminary. We can observe a tendency, that type 1 diabetes is associated with early impairment of elasticity of large arteries. This may be explained by the higher blood pressure in diabetic patients, but further subjects need to be included for final conclusion.