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Association of Carotid Artery Intima-Media Thickness with Complex Aortic Atherosclerosis in Patients with Recent Stroke

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

Emmanouil S. Brilakis, MD

Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN.

Biana Leybishkis, MD

Division of Internal Medicine, MCP Hahnemann University, Philadelphia, PA.

Marc Cohen, MD

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

Alexis B. Sokil, MD

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

Nelson Wolf, MD

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

Rose Lee Dorn, DO

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

Andrew Roberts, MD

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

William VanDecker, MD

Division of Cardiology, MCP Hahnemann University, Philadelphia, PA.

This study was undertaken to determine whether carotid intima-media thickness can predict complex aortic atherosclerosis. A retrospective review was conducted of 64 consecutive patients who underwent transesophageal echocardiography and carotid ultrasonography for evaluation of recent ischemic stroke at MCP Hahnemann University, Medical College of Pennsylvania Hospital between January 1, 1999, and December 31, 1999. The mean age was 65 ± 14 years and 59% of the patients were women. Thirty-nine patients (61 %) had carotid atherosclerosis (defined as an intima-media thickness 1 mm) and seven patients (11%) had complex aortic atherosclerosis (defined as the presence of protruding atheroma 4 mm thick, mobile atherosclerotic debris, or plaque ulceration in any aortic segment by transesophageal echocardiography). Compared to patients without complex aortic atherosclerosis, patients with complex aortic atherosclerosis were more likely to have hypercholesterolemia (19% vs 57%, p = 0.05) and a carotid intima-media thickness of 2 mm or greater (35% vs 86%, p = 0.02). A carotid intima-media thickness of 2 mm or more had 86% sensitivity, 65% specificity, 23% positive predictive value, 97% negative predictive value, 2.5 positive likelihood ratio, and 0.22 negative likelihood ratio for the diagnosis of complex aortic atherosclerosis. Carotid intima- media thickness measurement can be used to noninvasively estimate the probability of complex aortic atherosclerosis. A carotid intima-media thickness less than 2 mm makes complex aortic atherosclerosis very unlikely.

Angiology, Vol. 53, No. 2, 185-189 (2002)
DOI: 10.1177/000331970205300209


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