Carotid Intima-Media Thickness, Not Carotid Plaque, is Associated With Large Territory Cerebral Infarction in Patients With Ischemic Stroke

BACKGROUND AND OBJECTIVES: Carotid intima-media thickness (IMT) has been associated with an increased risk of ischemic stroke. To better understand this association, we evaluated the relationships of vascular risk factors, including carotid IMT and carotid plaque, and large territory cerebral infarction and small vessel stroke. SUBJECTS AND METHODS: A total of 502 patients with acute ischemic stroke were divided into two groups according to neurologic examinations and imaging studies; 1) a large territory infarction group (group I: n=126, 64.4±11 years, 78 males) and 2) a small vessel stroke group (group II: n=376, 62.5±11 years, 242 males). We evaluated associations between (a) territory and non-territory strokes and (b) age, sex, potential vascular risk factors, carotid image and cardiac function (by echocardiography). RESULTS: We did not find significant between group differences of age, sex, diabetes, previous history of ischemic stroke, plaque (presence, site and size of carotid plaque), and velocity of carotid blood flow and left ventricle ejection fraction. However, group I had a higher incidence of hypertension (p=0.006), smoking (p=0.003), and dyslipidemia (p=0.001). Group I had thicker carotid IMT than group II (right carotid: 0.81±0.21 mm vs. 0.76±0.19 mm, p=0.035; left carotid: 0.88±0.23 mm vs. 0.80±0.20 mm, p=0.014) and a higher e/e' level (12.08 vs. 9.66, p<0.001). Dyslipidemia, thicker carotid IMT and elevated E/E' ratios were significant independent predictors for large territory infarction in patients with ischemic stroke. CONCLUSION: Carotid IMT is significantly increased in patients with large territory infarction compared with those with small vessel stroke.