This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nagai, Y. Articles by Matsumoto, M. Search for Related Content PubMed PubMed Citation Articles by Nagai, Y. Articles by Matsumoto, M. Pubmed/NCBI databases Medline Plus Health Information Carotid Artery Disease Stroke Related Collections Imaging Doppler ultrasound, Transcranial Doppler etc. Risk Factors for Stroke

(Stroke. 2001;32:1780.)
© 2001 American Heart Association, Inc.

Original Contributions

Significance of Earlier Carotid Atherosclerosis for Stroke Subtypes

Yoji Nagai, MD, PhD; Kazuo Kitagawa, MD, PhD; Manabu Sakaguchi, MD; Yoshiomi Shimizu, MD; Hiroyuki Hashimoto, MD; Hiroshi Yamagami, MD; Masako Narita, MD; Toshiho Ohtsuki, MD, PhD; Masatsugu Hori, MD, PhD Masayasu Matsumoto, MD, PhD

From the Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine (Japan).

Correspondence to Yoji Nagai, MD, PhD, Division of Strokology, Department of Internal Medicine and Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan. E-mail nagaiy{at}medone.med.osaka-u.ac.jp

Background and Purpose—— In addition to advanced stenosis, earlier stages of carotid atherosclerosis are associated with the risk for stroke. However, the significance has not been established for specific stroke subtypes. This study examines the association of earlier carotid atherosclerosis with stroke subtypes.

Methods—— The subjects comprised 1059 patients (mean±SD age, 62±11 years) with <60% carotid stenosis. With the use of ultrasound, carotid atherosclerosis was evaluated by the plaque score, as defined by the sum of all plaque heights in bilateral carotid arteries. On the basis of neurological signs and symptoms, medical history, and brain MRI, we diagnosed stroke and its subtypes as follows: no stroke (n=738), atherothrombotic infarction (AI) (n=56), lacunar infarction (LI) (n=117), cardioembolic infarction (n=65), cerebral hemorrhage (n=26), and other or unclassified stroke (n=57).

Results—— The plaque score was higher in AI (10.5±5.9) and LI (6.0±5.1) groups than in the no-stroke group (4.3±4.9) (both P<0.05), although it was similar between other stroke groups and the no-stroke group. Each 1 SD greater plaque score was associated with 2.5-fold (95% CI, 2.0 to 3.2) higher risk for AI and 1.4-fold (95% CI, 1.2 to 1.7) higher risk for LI compared with the no-stroke group. When we adjusted for cardiovascular risk factors, plaque score remained significantly associated with AI but not with LI. By receiver operating characteristic curve analyses, the receiver operating characteristic area for AI (0.81 to 0.86) was greater than that for LI (0.62 to 0.67) when we used plaque score either alone or in combination with cardiovascular risk factors.

Conclusions—— Although evaluation of carotid atherosclerosis may aid in the risk assessment for AI and LI, the benefit appears to be greater for AI.

Key Words: atherosclerosis • carotid arteries • risk assessment • ultrasonography

This article has been cited by other articles:

				E.J. Lee, H.J. Kim, J.M. Bae, J.C. Kim, H.J. Han, C.S. Park, N.H. Park, M.S. Kim, and J.A. Ryu Relevance of Common Carotid Intima-Media Thickness and Carotid Plaque as Risk Factors for Ischemic Stroke in Patients with Type 2 Diabetes Mellitus AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 916 - 919. [Abstract] [Full Text] [PDF]

				M Kumagai, T Yamagishi, N Fukui, and M Chiba Carotid artery calcification seen on panoramic dental radiographs in the Asian population in Japan Dentomaxillofac. Radiol., February 1, 2007; 36(2): 92 - 96. [Abstract] [Full Text] [PDF]

				H. Sato, K. Ishikawa, A. Kitabatake, S. Ogawa, Y. Maruyama, Y. Yokota, T. Fukuyama, Y. Doi, S. Mochizuki, T. Izumi, et al. Low-Dose Aspirin for Prevention of Stroke in Low-Risk Patients With Atrial Fibrillation: Japan Atrial Fibrillation Stroke Trial Stroke, February 1, 2006; 37(2): 447 - 451. [Abstract] [Full Text] [PDF]

				T. Schachner, A. Zimmer, G. Nagele, G. Laufer, and J. Bonatti Risk factors for late stroke after coronary artery bypass grafting J. Thorac. Cardiovasc. Surg., August 1, 2005; 130(2): 485 - 490. [Abstract] [Full Text] [PDF]

				C. Jackson and C. Sudlow Are Lacunar Strokes Really Different?: A Systematic Review of Differences in Risk Factor Profiles Between Lacunar and Nonlacunar Infarcts Stroke, April 1, 2005; 36(4): 891 - 901. [Abstract] [Full Text] [PDF]

				M. E. Bleil, J. M. McCaffery, M. F. Muldoon, K. Sutton-Tyrrell, and S. B. Manuck Anger-Related Personality Traits and Carotid Artery Atherosclerosis in Untreated Hypertensive Men Psychosom Med, September 1, 2004; 66(5): 633 - 639. [Abstract] [Full Text] [PDF]

				H. Yamagami, K. Kitagawa, Y. Nagai, H. Hougaku, M. Sakaguchi, K. Kuwabara, K. Kondo, T. Masuyama, M. Matsumoto, and M. Hori Higher Levels of Interleukin-6 Are Associated With Lower Echogenicity of Carotid Artery Plaques Stroke, March 1, 2004; 35(3): 677 - 681. [Abstract] [Full Text] [PDF]

				L. Djousse, K. J. Rothman, L. A. Cupples, D. K. Arnett, and R. C. Ellison Relation Between Serum Albumin and Carotid Atherosclerosis: The NHLBI Family Heart Study Stroke, January 1, 2003; 34(1): 53 - 57. [Abstract] [Full Text] [PDF]

				J. Luedemann, U. Schminke, K. Berger, M. Piek, S. N. Willich, A. Doring, U. John, and C. Kessler Association Between Behavior-Dependent Cardiovascular Risk Factors and Asymptomatic Carotid Atherosclerosis in a General Population Stroke, December 1, 2002; 33(12): 2929 - 2935. [Abstract] [Full Text] [PDF]

				M. Hollander, M.L. Bots, A. I. del Sol, P.J. Koudstaal, J.C.M. Witteman, D.E. Grobbee, A. Hofman, and M.M.B. Breteler Carotid Plaques Increase the Risk of Stroke and Subtypes of Cerebral Infarction in Asymptomatic Elderly: The Rotterdam Study Circulation, June 18, 2002; 105(24): 2872 - 2877. [Abstract] [Full Text] [PDF]

				T. Sasaki, M. Watanabe, Y. Nagai, T. Hoshi, M. Takasawa, M. Nukata, A. Taguchi, K. Kitagawa, N. Kinoshita, and M. Matsumoto Association of Plasma Homocysteine Concentration With Atherosclerotic Carotid Plaques and Lacunar Infarction Stroke, June 1, 2002; 33(6): 1493 - 1496. [Abstract] [Full Text] [PDF]