Key result
Mean cIMT does not differentiate stroke subtypes, but carotid plaques are more prevalent in ischemic stroke.
Why the study?
Conventional risk factors overlap substantially across ischemic infarction, TIA, and intracerebral hemorrhage, and the distribution of carotid intima-media thickness and focal plaque across these phenotypes may clarify mechanistic differences beyond isolated vascular measurements.
Does bilateral common carotid intima-media thickness and carotid plaque topography differ across and independently discriminate between ischemic infarction, transient ischemic attack, and intracerebral hemorrhage in patients presenting with acute cerebrovascular events?
Cross-Sectional (n=443)
No
Does bilateral common carotid intima-media thickness and carotid plaque topography differ across and independently discriminate between ischemic infarction, transient ischemic attack, and intracerebral hemorrhage in patients presenting with acute cerebrovascular events?
Diffuse carotid intima-media thickening does not differentiate between ischemic infarction, TIA, and intracerebral hemorrhage, whereas focal carotid plaque is significantly more prevalent in completed ischemic infarction than in TIA.
These Level 5 data should not change practice; hypothesis-generating for distinct roles of plaque versus cIMT in cerebrovascular events.
Introduction: Carotid intima-media thickness (cIMT) and focal plaque represent related but distinct markers of vascular injury. Their distribution across ischemic infarction (INF), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) may clarify differences in cerebrovascular phenotypes. Because conventional risk factors overlap substantially, integrated carotid phenotyping may provide useful mechanistic information beyond isolated vascular measurements. Aims and objectives: To compare bilateral common carotid artery cIMT, inter-side asymmetry, plaque prevalence, laterality and topography across INF, TIA and ICH, and assess their independent association with clinical presentation. Materials and methods: This hospital-based study included 443 patients with cerebrovascular presentations: 238 INF, 113 TIA and 92 ICH. All underwent neuroimaging, laboratory evaluation and carotid Doppler ultrasonography. Right, left, mean and maximum CCA-IMT, asymmetry and plaque characteristics were analyzed. Kruskal-Wallis and chi-square tests, multinomial logistic regression, restricted cubic splines, sensitivity analyses and AUROC assessment with 10-fold cross-validation were performed. Results: Mean bilateral cIMT was similar in INF, TIA and ICH (1.10±0.23, 1.09±0.25 and 1.09±0.26 mm; P=0.751), with no significant difference in other cIMT measures. Among 374 patients with interpretable plaque coding, plaque prevalence was 60.6%, 42.6% and 57.1%, respectively (P=0.014), driven by INF versus TIA (Holm-adjusted P=0.011). Mean cIMT was not independently associated with INF or TIA versus ICH, but was associated with plaque presence (aOR 1.60 per SD, 95% CI 1.24-2.07; P<0.001). Cross-validated macro-AUROC was 0.485. Conclusion: Diffuse carotid wall thickening did not discriminate cerebrovascular presentation, whereas focal plaque prevalence differed, particularly between infarction and TIA. cIMT remains a marker of underlying carotid atherosclerotic burden rather than a stand-alone classifier of presentation subtype.
No takes yet. Share an insight, caveat, or question.
Saha et al. (2026) conducted a cross-sectional in Acute cerebrovascular events (ischemic infarction, transient ischemic attack, intracerebral hemorrhage) (n=443). Mean bilateral common carotid artery intima-media thickness (cIMT) and carotid plaque phenotype vs. Intracerebral hemorrhage (ICH) as the reference group (versus INF and TIA) was evaluated on Independent association of mean bilateral cIMT (per 1-SD increase) with ischemic infarction (INF) versus intracerebral hemorrhage (ICH) (OR 1.07, 95% CI 0.82-1.41, p=0.607). Mean bilateral cIMT did not differ across INF, TIA, and ICH (P=0.751; aOR 1.07 for INF vs ICH), whereas carotid plaque prevalence was higher in INF than TIA (60.6% vs 42.6%, P=0.011).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: