Common carotid intima media thickness as a marker of clinical severity in patients with symptomatic extracranial carotid artery stenosis

Clin Neurol Neurosurg. 2009 Apr;111(3):246-50. doi: 10.1016/j.clineuro.2008.10.007. Epub 2008 Nov 25.


Objectives: Increased common carotid artery intima-media thickness (CCA-IMT) is a risk factor for ischemic stroke and especially large vessel atherothrombotic infarction. However, the potential association of stroke severity with the intima-media thickening has not been previously studied. We sought to investigate the association between CCA-IMT and clinical severity of ischemic stroke in patients with symptomatic extracranial carotid artery stenosis (SCAS).

Patients and 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. Stroke severity was assessed using the National Institute of Health Stroke Scale (NIHSS) on hospital admission and Barthel Ambulatory Index (BI) at hospital discharge.

Results: CCA-IMT was strongly correlated to NIH (Spearman's correlation coefficient: 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 increasing NIHSS-scores on hospital admission (beta: 0.510; p<0.001) and decreasing BI-scores at hospital discharge (beta: -0.483; p<0.001) even after adjustment for demographic characteristics and cardiovascular risk factors. After including baseline stroke severity (NIHSS) in the multivariate linear regressions models evaluating early functional outcome, only NIHSS was independently related to BI (standardized linear regression coefficient: -0.776, p<0.001), while the initial association between IMT and BI did not retain its statistical significance (beta: -0.074, p=0.276).

Conclusions: Increased CCA-IMT is independently associated with more severe stroke on admission in patients with SCAS.

MeSH terms

  • Acute Disease
  • Aged
  • Brain Ischemia / etiology
  • Brain Ischemia / pathology*
  • Carotid Artery, Common / diagnostic imaging
  • Carotid Artery, Common / pathology
  • Carotid Stenosis / complications
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / pathology*
  • Female
  • Humans
  • Linear Models
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Severity of Illness Index
  • Stroke / pathology*
  • Tunica Intima / diagnostic imaging
  • Tunica Intima / pathology*
  • Tunica Media / diagnostic imaging
  • Tunica Media / pathology*
  • Ultrasonography, Doppler, Color