Correlation of common carotid artery intima media thickness, intracranial arterial stenosis and post-stroke cognitive impairment

Yong-Hui Lee, Shoou-Jeng Yeh
Acta Neurologica Taiwanica 2007, 16 (4): 207-13

BACKGROUND AND PURPOSE: Atherosclerosis of the intracranial arteries is a well-recognized cause of ischemic stroke in Asians, and extracranial carotid artery disease is more often seen in western countries. The relationship of common carotid artery intima-media thickness (CCA-IMT), intracranial arteries stenosis (ICS) and vascular cognitive impairment (VCI) after ischemic stroke has not been fully elucidated. In this study, we investigated the relationship between CCA-IMT and the severity of ICS and VCI.

METHODS: We recruited patients from December 2004, to June 2005, with the inclusion criteria: (1) first-ever ischemic stroke, (2) admission within 3 days of stroke onset, (3) under 80 years old, and (4) no previous dementia history. We excluded patients with stroke scores greater than an NIHSS of 15; those with recurrent stroke, and those with extracranial internal carotid artery stenosis > 50%. All the patients underwent brain MR angiography, carotid ultrasonography and neuropsychological testing during hospitalization and at 3 months after stroke. We defined the percent of ICS using the method of Warfarin-Aspirin Symptomatic Intracranial Disease. Measurement of CCA-IMT was made on the far wall of the common carotid artery, 1.5 cm proximal to the bifurcation at a point free of plaques. Cognitive performance was assessed using the Cognition Assessment State Instrument (CASI).

RESULTS: Thirty patients (21M/9F, mean age 65.97 +/- 10.33 years) were studied. The initial CCA-IMT was 1.04 +/- 0.59 mm and the initial CASI was 64.73 +/- 14.75. The ICS was 70 +/- 26%. At 3 months after stroke, the CCA-IMT was 1.06 +/- 0.59 mm; and CASI was 70.07 +/- 18.50. Compared with patients with CCA-IMT > 0.87 mm, those with CCA-IMT < or = 0.87 mm had lower ICS (57 +/- 23% vs. 81 +/- 24%, p = 0.013), but similar initial CASI score (67.92 +/- 13.52 vs. 61.93 +/- 16.64, p = 0.28). The improvement of CASI score at 3 months was significantly higher in patients with CCA-IMT < or = 0.87 mm (67.92 +/- 13.52 vs. 77.36 +/- 14.12, p = 0.001), than those with CCA-IMT > 0.87 mm (61.93 +/- 16.64 vs. 63.69 +/- 19.89, p = 0.612).

CONCLUSIONS: CCA-IMT might be associated with the severity of ICS and VCI at 3 months after the first-ever ischemic stroke. The patients with lower CCA-IMT had a better CASI evaluation at 3 months after stroke. A larger scale of study to explore the association of CCA-IMT, VCI and ICS at 3 months after stroke might help farther delineation of these relationships.

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