Carotid intima media thickness as an usefull tool in predicting cerebrovaskular events Poster No.: C-0005 Congress: ECR 2015 Type: Authors: Keywords: DOI: Scientific Exhibit A. Rahimic - Catic; Sarajevo/BA Cardiovascular system, Arteries / Aorta, Ultrasound-Colour Doppler, Diagnostic procedure, Radiation safety, Statistics, Arteriosclerosis, Ischemia / Infarction 10.1594/ecr2015/C-0005 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 9
Aims and objectives Cardiovascular disease (CVD), including stroke and heart diseases remains the leading cause of death worldwide. Carotid artery atherosclerosis is one of important factors in developing of stroke and heart disease [1]. Intima media thickness (IMT) is an early indicator of carotid atherosclerosis, as well as of general atherosclerosis, and it can be used to predict cerebrovascular events. IMT up to 0,8 mm is considered normal, superior to 1,0 mm abnormal, while value of IMT 0,8-1.0 mm is considered borderline. Mean IMT of 0.8-1.0 mm at baseline is associated with at least a twofold greater hazard rate of subsequent ischemic stroke, and having a mean IMT above 1.0 mm is associated with a three to fourfold greater hazard rate [2]. Early detection of atherosclerosis is important in order to prevent stroke and heart diseases and it can be easily and non-invasively detected by carotid ultrasound which is highly reliable and reproducible. Images for this section: Fig. 1: Ultrasound image of Carotid arteries Page 2 of 9
Methods and materials A total of 120 patients were included in prospective study, which was carried out on patients who underwent Color Doppler Flow Imaging (CDFI) at the Clinic of Radiology, Clinical Center University of Sarajevo. Younger than 40 and older than 65 were excluded from study. There were 60 patients with stroke, 30 patients with transient ischemic attack (TIA) and 30 patients with no symptoms of either stoke or TIA. Mesurings included peak systolic velocity (PSV) and end diastolic velocity (ED) measurements of bilateral common carotid arteries (CCA) and internal carotid arteries (ICA). Common carotid artery intimal-medial thickness (CCA-IMT) on both sides was measured three times, and IMT value was considered the mean value of these six measurements. The criteria for grading carotid arteries stenosis was determined by American Society of Radiologists in Ultrasound Consensus Conference [3] and are presented in Table 1. Table 1. The criteria for grading carotid arteries stenosis Degree stenosis (%) of Primary parameters ICA PSV (cm/s) Degree plaque ACI (%) of Additional parameters ICA/CCA PSV Ratio Normal < 125 no reduction < 2.0 < 40 < 50% <125 < 50 < 2.0 <40 50-69% 125-230 # 50 2.0-4.0 40-100 #70% >230 # 50 > 4.0 > 100 95-99% High, low or undetectable Occlusion Undetectable No detected lumen ICA EDV (cm/s) Visible Variable Variable Undetectable Undetectable Statistical analysis was performed using SPSS 20, with the Mann-Whitney test and Kruskal-Wallis test for comparing continuous variables and the chi-square test used for categorical variables. The level of statistical significance was set at p<0.05. Page 3 of 9
Images for this section: Fig. 2: IMT measurement Page 4 of 9
Results 120 patients were identified, of which 64 patients were female (53,3%) and 56 patients were male (46,7%). Age range was 40-65 (Mean 55,4 ± 7,0). Mean IMT value was 0,84 ± 0,20 mm, the lowest IMT value was 0,53 mm and the highest IMT value was 1,53 mm. Patients with stroke had higher IMT values (Mean 0,89±0,20 mm). Patients with TIA also had high IMT values (0,83±0,20 mm), while patients with no symptoms of stroke and TIA had the lowest IMT values (Mean 0,74±0,15 mm). The difference was statistically significant (Kruskal - Wallis test, p=0,001). Binary logistic regression showed that IMT superior to 1,0 mm increases hazard rete of stroke by 4,2 times (p=0,006). Most patients were with no stenosis (50,84%), stenosis <70% was found in 40,83% patients, stenosis >70% in 5,83% patients and occlusion in 2,5% patients. Even though patients with stroke had stenosis more often, and occlusion was found only in patients with stroke, the difference between groups was not statistically significant (Chi-square test, p=0,455). Positive correlation was also found between IMT and age, as well as between IMT and sex. Males have higher IMT (Mean 0,91±0,21 mm) than females (Mean 0,77±0,16 mm), the difference was statistically significant (Mann - Whitney test, p<0,001). Patients with normal IMT had mean age 51,9 ± 6,5 years, patients with borderline IMT had mean age 58,0 ± 5,9 years, while patients with abnormal IMT had mean age 59,3 ± 5,9 years. Older patients have higher IMT, the difference was statistically significant (Kruskal - Wallis test, p<0,001). Images for this section: Page 5 of 9
Fig. 3: ICA PSV 160 cm/s, 50-69% stenosis Page 6 of 9
Fig. 4: Fibrolipid plaque causing significant stenosis Page 7 of 9
Fig. 5: CCA occlusion Page 8 of 9
Conclusion Carotid ultrasound is a noninvasive method of choice for detection of carotid atherosclerosis and IMT can be used to predict cerebrovascular events. IMT superior to 1,0 mm is associated with a greater stroke hazard rate, and is more important predictor than stenosis. Personal information Rahimic - Catic Ajla, M.D. Clinical University Center of Sarajevo, Clinic of Radiology Sarajevo, Bosnia and Herzegovina catic.ajla@yahoo.com References 1. Flaherty ML, Kissela B, Khoury JC, Alwell K, Moomaw CJ, Woo D,et al. Carotid artery stenosis as a cause of stroke. Neuroepidemiology 2013; 40:36-41. 2. Chambless LE, Folsom AR, Clegg LX, Sharrett AR, Shahar E, Nieto FJ, et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol. 2000; 151(5): 478-487. 3. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. Carotid artery stenosis: Gray-scale and Doppler US diagnosis - society of radiologists in ultrasound consensus conference. Radiology 2003; 229:340-346. Page 9 of 9