Increased intima media thickness and atherosclerotic plaques in the carotid artery as risk factors for silent brain infarcts

Kazuo Inoue, Masatoshi Matsumoto, Teiji Shono, Satoshi Toyokawa, Akihito Moriki
Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association 2007, 16 (1): 14-20
The presence of silent cerebral infarcts (SCIs), defined as lesions > or = 3 mm in diameter on magnetic resonance imaging (MRI), is considered a predictor of symptomatic cerebrovascular disorders (CVDs). Similarly, SCI-like lesions < 3 mm in diameter, lesions which often occur in the deep white matter and basal ganglia, also may be a risk factor for CVD. This study evaluated the relationships between SCI and SCI-like brain lesions, as defined by MRI, and 2 findings on extracranial carotid ultrasonography: intima-media thickness (IMT) and atherosclerotic plaque. We studied data obtained by carotid ultrasonography and cerebral MRI in 448 consecutive subjects without a history of stroke who had undergone comprehensive brain screening (mean age, 51.1 years). The subjects were classified into 4 groups according to the presence of increased (> or = 1 mm) IMT (I) and plaque (P). A total of 110 subjects demonstrated increased IMT (24.6%), and 54 subjects had increased plaque (12.1%). SCI-like lesions were found in 38 subjects (8.5%); single SCI, in 24 (5.4%); and multiple SCIs, in 51 (11.4%). Frequencies of SCI-like lesion(s), single SCI, and multiple SCIs were 6.1%, 12.2%, and 8.7%, respectively, in the I(-)P(-) group; 14.6%, 22.0%, and 13.4% in the I(+)P(-) group; 7.7%, 30.8%, and 26.9% in the I(-)P(+) group; and 17.9%, 39.3%, and 21.4% in the I(+)P(+) group. Multivariate analysis found that the presence of carotid plaques was significantly associated with (1) SCI-like lesion(s) and SCI (odds ratio [OR] = 2.20; 95% confidence interval [CI] = 1.17-4.34), (2) single and multiple SCI (OR = 2.33; 95% CI = 1.16-4.67), and (3) multiple SCIs (OR = 2.31; 95% CI = 1.06-5.03). However, the presence of increased carotid IMT was not significantly associated with any of these 3 categories. Coexistence of increased IMT and plaque was more strongly correlated with SCI than with either lesion alone.

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