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Current Neurovascular Research


ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Research Article

Dynamic Changes of Carotid Atherosclerosis and Their Relation with Stroke Recurrence in Patients with Stroke or Transient Ischemic Attack

Author(s): Eun-Ye Lim and A-Hyun Cho*

Volume 19, Issue 3, 2022

Published on: 16 September, 2022

Page: [303 - 310] Pages: 8

DOI: 10.2174/1567202619666220822141804

Price: $65


Background and Purpose: The purpose of this study was to show dynamic changes in carotid and vertebral artery using carotid Doppler ultrasonography (DUS) through a long-term follow- up exam, and determine their associations with stroke recurrence.

Methods: We consecutively enrolled stroke or transient ischemic attack (TIA) patients who had undergone DUS more than twice with intervals of three months or more. Stroke recurrence during follow-up was also investigated by reviewing medical records. Progress or regress of plaque was defined as more than 0.1 mm change from the initial scan with a semi-quantitative measurement. The development of new plaque was also regarded as plaque progress. Increased intima-media thickness and plaque presence were interpreted at the initial and follow-up scans. Factors related to progression or regression were analyzed. The relationship between plaque change and stroke recurrence was investigated.

Results: A total of 201 patients were enrolled (186 ischemic stroke patients and 15 TIA patients). There were 61 (30.3%) females. Their mean age was 64.2 ± 9.9 years. During a follow-up of 35.0 ± 22.6 (mean ± SD) months, plaque progress was observed in 92 (45.8%) and plaque regress in 13 (6.5%). Stroke recurred in 18 patients. Plaque progression showed no significant association with age, risk factors, statin use, or subtype. After adjustment of age, sex, diabetes, and stroke subtype, multiple logistic regression showed a significant association of plaque progression with stroke recurrence (odds ratio: 3.8, 95% confidence interval: 1.1 to 13.1, p = 0.034). Patients with plaque regress were significantly younger than those without plaque regress (57.8 years vs. 64.6 years, p = 0.041).

Conclusion: Plaque progression occurred in 46% of stroke or TIA patients. Plaque progression was significantly associated with clinical stroke recurrence. Plaque regressed in 6.5% of patients. Patients with regression were younger than those without.

Keywords: Carotid atherosclerosis, ultrasonography, stroke, transient ischemic attack, prognosis, stroke recurrence.

Ovbiagele B, Nguyen-Huynh MN. Stroke epidemiology: Advancing our understanding of disease mechanism and therapy. Neurotherapeutics 2011; 8(3): 319-29.
[] [PMID: 21691873]
Fairhead JF, Mehta Z, Rothwell PM. Population-based study of delays in carotid imaging and surgery and the risk of recurrent stroke. Neurology 2005; 65(3): 371-5.
[] [PMID: 16087900]
Silvestrini M, Altamura C, Cerqua R, et al. Ultrasonographic markers of vascular risk in patients with asymptomatic carotid stenosis. J Cereb Blood Flow Metab 2013; 33(4): 619-24.
[] [PMID: 23361391]
Nambi V, Chambless L, Folsom AR, et al. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: The ARIC (Atherosclerosis Risk In Communities) study. J Am Coll Cardiol 2010; 55(15): 1600-7.
[] [PMID: 20378078]
Adams A, Bojara W, Schunk K. Early Diagnosis and Treatment of Coronary Heart Disease in Asymptomatic Subjects With Advanced Vascular Atherosclerosis of the Carotid Artery (Type III and IV b Findings Using Ultrasound) and Risk Factors. Cardiol Res 2018; 9(1): 22-7.
[] [PMID: 29479382]
Jahromi AS, Cinà CS, Liu Y, Clase CM. Sensitivity and specificity of color duplex ultrasound measurement in the estimation of internal carotid artery stenosis: A systematic review and meta-analysis. J Vasc Surg 2005; 41(6): 962-72.
[] [PMID: 15944595]
U-King-Im JM. Young V, Gillard JH. Carotid-artery imaging in the diagnosis and management of patients at risk of stroke. Lancet Neurol 2009; 8(6): 569-80.
[] [PMID: 19446276]
Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45(7): 2160-236.
[] [PMID: 24788967]
Chen PC, Jeng JS, Hsu HC, Su TC, Chien KL, Lee YT. Carotid atherosclerosis progression and risk of cardiovascular events in a community in Taiwan. Sci Rep 2016; 6(1): 25733.
[] [PMID: 27169625]
Touboul PJ, Hennerici MG, Meairs S, et al. Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012; 34(4): 290-6.
[] [PMID: 23128470]
Boussel L, Arora S, Rapp J, et al. Atherosclerotic plaque progression in carotid arteries: Monitoring with high-spatial-resolution MR imaging-multicenter trial. Radiology 2009; 252(3): 789-96.
[] [PMID: 19508991]
van Gils MJ, Vukadinovic D, van Dijk AC, Dippel DWJ, Niessen WJ, van der Lugt A. Carotid atherosclerotic plaque progression and change in plaque composition over time: A 5-year follow-up study using serial CT angiography. Am J Neuroradiol 2012; 33(7): 1267-73.
[] [PMID: 22345501]
Saxena A, Ng EYK, Lim ST. Imaging modalities to diagnose carotid artery stenosis: Progress and prospect. Biomed Eng Online 2019; 18(1): 66.
[] [PMID: 31138235]
Crouse JR III, Raichlen JS, Riley WA, et al. Effect of rosuvastatin on progression of carotid intima-media thickness in low-risk individuals with subclinical atherosclerosis: The METEOR Trial. JAMA 2007; 297(12): 1344-53.
[] [PMID: 17384434]
Yonemura A, Momiyama Y, Fayad ZA, et al. Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques: A 2-year follow-up by noninvasive MRI. Eur J Cardiovasc Prev Rehabil 2009; 16(2): 222-8.
[] [PMID: 19242355]
Sipahi I, Nicholls SJ, Tuzcu EM, Nissen SE. Coronary atherosclerosis can regress with very intensive statin therapy. Cleve Clin J Med 2006; 73(10): 937-44.
[] [PMID: 17044319]
Lorenz MW, Polak JF, Kavousi M, et al. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): A meta-analysis of individual participant data. Lancet 2012; 379(9831): 2053-62.
[] [PMID: 22541275]
Polak JF, Pencina MJ, O’Leary DH, D’Agostino RB. Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis. Stroke 2011; 42(11): 3017-21.
[] [PMID: 21885840]
Migdalski A, Jawien A. New insight into biology, molecular diagnostics and treatment options of unstable carotid atherosclerotic plaque: A narrative review. Ann Transl Med 2021; 9(14): 1207.
[] [PMID: 34430648]
Gerhardt T, Haghikia A, Stapmanns P, Leistner DM. Immune mechanisms of plaque instability. Front Cardiovasc Med 2022; 8: 797046.
[] [PMID: 35087883]
Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res 2014; 114(12): 1852-66.
[] [PMID: 24902970]
Ammirati E, Moroni F, Norata GD, Magnoni M, Camici PG. Markers of inflammation associated with plaque progression and instability in patients with carotid atherosclerosis. Mediators Inflamm 2015; 2015: 1-15.
[] [PMID: 25960621]

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