Bilateral common carotid artery ultrasound for prediction of incident strokes using intima-media thickness and external diameter

An observational study

Marsha L. Eigenbrodt, Gregory W. Evans, Kathryn M. Rose, Zoran Bursac, Richard E. Tracy, Jawahar L. Mehta, David J. Couper

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: External common carotid artery (CCA) diameter and intima-media thickness (IMT) are independently associated with incident stroke and other cardiovascular events. Arterial geometry such as large IMT and large diameter may reflect vulnerable plaques and so impact stroke risk. Finally, arterial changes that exist bilaterally may increase stroke risk. Method. We studied middle-aged men and women (n=7276) from a prospective observational study who had right (R) and left (L) CCA IMT and external diameters measured via B-mode ultrasound (1987-89) in order to categorize CCA geometry. Using side- and gender-specific IMT and diameter medians, we categorized each measurement as large (≥ median) vs. not large (< median) and defined four geometries: both IMT and diameter were large, only one parameter was large, or neither was large (reference group). Participants were followed for first time stroke through December 31, 1999. We used proportional hazards models to assess associations between right and left CCA geometries with new stroke. We also calculated positive and negative likelihood ratios (+LR and -LR) for CCA bilateral phenotypes as a measure of diagnostic accuracy. Results: Presence of both large CCA IMT and large diameter on one side was associated with strong stroke risk even after risk factor adjustment (men: RCCA hazard ratio [HR]=3.7 95% confidence interval [CI]=1.9-7.4; LCCA HR=2.4 95% CI=1.4-4.4; women: RCCA HR=4.0 95% CI=1.5-10.5; LCCA HR=5.7 95% CI=1.7-19.0). Presence of both large IMT and large diameter bilaterally was the strongest predictor of stroke identifying 64% of women and 44% of men who developed strokes. This phenotype showed potential for predicting stroke among individuals (women: +LR=3.1, 95% CI=2.6-3.8; men: +LR=2.3, 95% CI=1.8-2.8). Conclusion: Bilateral carotid artery geometries may be useful for stroke risk prediction.

Original languageEnglish (US)
Article number22
JournalCardiovascular Ultrasound
Volume11
Issue number1
DOIs
StatePublished - Jun 18 2013

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Common Carotid Artery
Observational Studies
Stroke
Confidence Intervals
Carotid Intima-Media Thickness
Phenotype
Risk Adjustment
External Carotid Artery
Carotid Arteries
Proportional Hazards Models
Myocardial Infarction
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Bilateral common carotid artery ultrasound for prediction of incident strokes using intima-media thickness and external diameter : An observational study. / Eigenbrodt, Marsha L.; Evans, Gregory W.; Rose, Kathryn M.; Bursac, Zoran; Tracy, Richard E.; Mehta, Jawahar L.; Couper, David J.

In: Cardiovascular Ultrasound, Vol. 11, No. 1, 22, 18.06.2013.

Research output: Contribution to journalArticle

Eigenbrodt, Marsha L. ; Evans, Gregory W. ; Rose, Kathryn M. ; Bursac, Zoran ; Tracy, Richard E. ; Mehta, Jawahar L. ; Couper, David J. / Bilateral common carotid artery ultrasound for prediction of incident strokes using intima-media thickness and external diameter : An observational study. In: Cardiovascular Ultrasound. 2013 ; Vol. 11, No. 1.
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abstract = "Background: External common carotid artery (CCA) diameter and intima-media thickness (IMT) are independently associated with incident stroke and other cardiovascular events. Arterial geometry such as large IMT and large diameter may reflect vulnerable plaques and so impact stroke risk. Finally, arterial changes that exist bilaterally may increase stroke risk. Method. We studied middle-aged men and women (n=7276) from a prospective observational study who had right (R) and left (L) CCA IMT and external diameters measured via B-mode ultrasound (1987-89) in order to categorize CCA geometry. Using side- and gender-specific IMT and diameter medians, we categorized each measurement as large (≥ median) vs. not large (< median) and defined four geometries: both IMT and diameter were large, only one parameter was large, or neither was large (reference group). Participants were followed for first time stroke through December 31, 1999. We used proportional hazards models to assess associations between right and left CCA geometries with new stroke. We also calculated positive and negative likelihood ratios (+LR and -LR) for CCA bilateral phenotypes as a measure of diagnostic accuracy. Results: Presence of both large CCA IMT and large diameter on one side was associated with strong stroke risk even after risk factor adjustment (men: RCCA hazard ratio [HR]=3.7 95{\%} confidence interval [CI]=1.9-7.4; LCCA HR=2.4 95{\%} CI=1.4-4.4; women: RCCA HR=4.0 95{\%} CI=1.5-10.5; LCCA HR=5.7 95{\%} CI=1.7-19.0). Presence of both large IMT and large diameter bilaterally was the strongest predictor of stroke identifying 64{\%} of women and 44{\%} of men who developed strokes. This phenotype showed potential for predicting stroke among individuals (women: +LR=3.1, 95{\%} CI=2.6-3.8; men: +LR=2.3, 95{\%} CI=1.8-2.8). Conclusion: Bilateral carotid artery geometries may be useful for stroke risk prediction.",
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T2 - An observational study

AU - Eigenbrodt, Marsha L.

AU - Evans, Gregory W.

AU - Rose, Kathryn M.

AU - Bursac, Zoran

AU - Tracy, Richard E.

AU - Mehta, Jawahar L.

AU - Couper, David J.

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N2 - Background: External common carotid artery (CCA) diameter and intima-media thickness (IMT) are independently associated with incident stroke and other cardiovascular events. Arterial geometry such as large IMT and large diameter may reflect vulnerable plaques and so impact stroke risk. Finally, arterial changes that exist bilaterally may increase stroke risk. Method. We studied middle-aged men and women (n=7276) from a prospective observational study who had right (R) and left (L) CCA IMT and external diameters measured via B-mode ultrasound (1987-89) in order to categorize CCA geometry. Using side- and gender-specific IMT and diameter medians, we categorized each measurement as large (≥ median) vs. not large (< median) and defined four geometries: both IMT and diameter were large, only one parameter was large, or neither was large (reference group). Participants were followed for first time stroke through December 31, 1999. We used proportional hazards models to assess associations between right and left CCA geometries with new stroke. We also calculated positive and negative likelihood ratios (+LR and -LR) for CCA bilateral phenotypes as a measure of diagnostic accuracy. Results: Presence of both large CCA IMT and large diameter on one side was associated with strong stroke risk even after risk factor adjustment (men: RCCA hazard ratio [HR]=3.7 95% confidence interval [CI]=1.9-7.4; LCCA HR=2.4 95% CI=1.4-4.4; women: RCCA HR=4.0 95% CI=1.5-10.5; LCCA HR=5.7 95% CI=1.7-19.0). Presence of both large IMT and large diameter bilaterally was the strongest predictor of stroke identifying 64% of women and 44% of men who developed strokes. This phenotype showed potential for predicting stroke among individuals (women: +LR=3.1, 95% CI=2.6-3.8; men: +LR=2.3, 95% CI=1.8-2.8). Conclusion: Bilateral carotid artery geometries may be useful for stroke risk prediction.

AB - Background: External common carotid artery (CCA) diameter and intima-media thickness (IMT) are independently associated with incident stroke and other cardiovascular events. Arterial geometry such as large IMT and large diameter may reflect vulnerable plaques and so impact stroke risk. Finally, arterial changes that exist bilaterally may increase stroke risk. Method. We studied middle-aged men and women (n=7276) from a prospective observational study who had right (R) and left (L) CCA IMT and external diameters measured via B-mode ultrasound (1987-89) in order to categorize CCA geometry. Using side- and gender-specific IMT and diameter medians, we categorized each measurement as large (≥ median) vs. not large (< median) and defined four geometries: both IMT and diameter were large, only one parameter was large, or neither was large (reference group). Participants were followed for first time stroke through December 31, 1999. We used proportional hazards models to assess associations between right and left CCA geometries with new stroke. We also calculated positive and negative likelihood ratios (+LR and -LR) for CCA bilateral phenotypes as a measure of diagnostic accuracy. Results: Presence of both large CCA IMT and large diameter on one side was associated with strong stroke risk even after risk factor adjustment (men: RCCA hazard ratio [HR]=3.7 95% confidence interval [CI]=1.9-7.4; LCCA HR=2.4 95% CI=1.4-4.4; women: RCCA HR=4.0 95% CI=1.5-10.5; LCCA HR=5.7 95% CI=1.7-19.0). Presence of both large IMT and large diameter bilaterally was the strongest predictor of stroke identifying 64% of women and 44% of men who developed strokes. This phenotype showed potential for predicting stroke among individuals (women: +LR=3.1, 95% CI=2.6-3.8; men: +LR=2.3, 95% CI=1.8-2.8). Conclusion: Bilateral carotid artery geometries may be useful for stroke risk prediction.

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