Published Online
on February 22, 2007

A more recent version of this article appeared on April 1, 2007

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Submitted on November 6, 2006
Accepted on November 14, 2006

Carotid Intima-Media Thickness Is Different in Large- and Small-Vessel Ischemic Stroke. The SMART Study

D. Martijn O. Pruissen MD; Susan A.M. Gerritsen; Talitha J. Prinsen MSc; Joke M. Dijk MD, PhD; L. Jaap Kappelle MD, PhD; Ale Algra MD, PhD, FAHA^*; on behalf of the SMART Study Group

From the Department of Neurology, Rudolf Magnus Institute of Neuroscience (D.M.O.P., S.A.M.G., T.J.P., L.J.K., A.A.), Utrecht, The Netherlands; the Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center, Utrecht, The Netherlands; and the Department of Neurology (J.M.D.), Academic Medical Center, Amsterdam, The Netherlands.

^* To whom correspondence should be addressed. E-mail: a.algra{at}umcutrecht.nl.

Background and Purpose--The role of athersclerosis in the difference between the pathogenesis of large-vessel disease (LVD) and small-vessel disease (SVD) is a matter of debate. Common carotid artery intima-media thickness (CCA IMT) is a marker of atherosclerosis. Our aim was to compare CCA IMT between SVD and LVD patients.

Methods--Two independent observers classified ischemic stroke or transient ischemic attack as caused by SVD or LVD, primarily based on imaging and in addition on clinical features. Mean CCA IMT was calculated based on 6 measurements for each patient.

Results--Four hundred and seventeen patients were classified LVD and 115 SVD. Mean CCA IMT was higher in patients with LVD (1.08 mm) than in patients with SVD (0.92 mm). The crude mean difference was 0.16 mm (95% CI, 0.09 to 0.23). After adjustment for age, sex and hypertension, the mean difference was 0.11 mm (95% CI, 0.05 to 0.18).

Conclusions--CCA IMT is higher in LVD patients than in SVD patients supporting the hypothesis that LVD and SVD have a different pathogenesis.

Key words: atherosclerosis • brain ischemia • intima-media thickness • lacunar infarcts • pathogenesis • risk factors • stroke subtype • symptomatic carotid stenosis • transient ischemic attack

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