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PAPER |
1 Department of Neurology and Clinical Neurophysiology, Albert-Ludwigs-Universität Freiburg, Germany
2 Department of Angiology and Cardiology, Albert-Ludwigs-Universität Freiburg, Germany
3 Institute of Medical Biometrics and Statistics, Albert-Ludwigs-Universität Freiburg, Germany
Correspondence to:
Correspondence to:
Dr A Harloff
Department of Neurology and Clinical Neurophysiology, Albert-Ludwigs-Universität, Breisacher Straße 64, D-79106 Freiburg (Germany); harloff{at}nz.ukl.uni-freiburg.de
Objectives: This study investigated (a) the hypothesis that stroke patients with aortic atheroma would show comparable atherosclerotic changes in the carotid arteries, which are easily accessible for ultrasound evaluation and (b) the possibility of carotid duplex sonography as a replacement for transoesophageal echocardiography (TEE) for the exclusion or prediction of relevant aortic plaques.
Methods: In 301 consecutive patients (mean age 62 years) with acute cerebral ischaemia, two dimensional ultrasound measurements were taken of common carotid artery intima media thickness (IMT) and maximal plaque area (PA) and the local degree of internal carotid artery (ICA) stenosis were determined. Maximal aortic wall thickness (AWT) was assessed by TEE.
Results: An IMT 
0.9 mm yielded a negative predictive value (NPV) of 95.8% for exclusion of aortic atheromas 
4 mm and an NPV of 100% for the exclusion of aortic thrombi. However, positive predictive value of IMT >0.9 mm was low (29.6%), increasing only slightly in the presence of carotid plaques (33%). Incidence of aortic thrombi was significantly higher with 50% compared with <50% ICA stenosis (11.3% v 3.9%, respectively). IMT and PA correlated moderately with AWT (r = 0.47, r = 0.53, respectively; p<0.001). Systolic blood pressure, coronary heart disease and peripheral artery disease, increased IMT, and ICA stenosis 50% were independently related to AWT 4 mm.
Conclusions: A high NPV of normal carotid ultrasound does not support routine TEE for the exclusion of complex aortic plaques as a high risk source of cerebral embolism. However, in patients with carotid atherosclerosis, particularly in those with ICA stenosis 50%, TEE should be performed to exclude an additional high risk source for stroke.
Abbreviations: AWT, aortic wall thickness; CCA, common carotid artery; DA, dimensions of atherosclerosis; HbA1c, glycosylated haemoglobin; ICA, internal carotid artery; IMT, intima media thickness; NPV, negative predictive value; PA, plaque area; PPV, positive predictive value; TEE, transoesophageal echocardiography
Keywords: atherosclerosis; carotid arteries; aorta; ultrasound; ischaemic stroke
This article has been cited by other articles:
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  A. Harloff, C. Strecker, M. Reinhard, M. Kollum, M. Handke, M. Olschewski, C. Weiller, and A. Hetzel Combined Measurement of Carotid Stiffness and Intima-Media Thickness Improves Prediction of Complex Aortic Plaques in Patients With Ischemic Stroke Stroke, November 1, 2006; 37(11): 2708 - 2712. [Abstract] [Full Text] [PDF]
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 H. S. Nam, S. W. Han, J. Y. Lee, S. H. Ahn, J. W. Ha, S. J. Rim, B. I. Lee, and J. H. Heo Association of aortic plaque with intracranial atherosclerosis in patients with stroke. Neurology, October 10, 2006; 67(7): 1184 - 1188. [Abstract] [Full Text] [PDF]
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