title: Value of carotid intima-media thickness and significant carotid stenosis as markers of stroke recurrence.
abstract: OBJECTIVE
  Data on the predictive value of carotid intima-media thickness (IMT) for stroke recurrence are scarce. We sought to analyze outcome differences in stroke patients with high IMT values compared with patients with significant carotid stenosis (SCS).
  
  
  METHODS
  The multicenter observational ARTICO study included 620 independent patients older than 60 years with a first-ever noncardioembolic stroke. Patients were followed-up for 1 year. The primary end point was a composite of cardiovascular events and death. The IMT-ARTICO substudy analyzed ultrasonographic data from 599 patients. After Doppler carotid echography, patients were classified into the SCS group (carotid stenosis ≥50%; 117 cases), high IMT group (patients with the common carotid IMT in the highest quartile ≥1.11 mm and without SCS; 110 cases), and control group (stroke patients with an IMT <1.11 mm and without SCS; 372 cases). We analyzed the impact of both conditions on the primary end point.
  
  
  RESULTS
  During follow-up, 88 patients (14.7%) had an end point event. Univariate analysis showed that male gender, diabetes, symptomatic peripheral arterial disease, ankle brachial index ≤0.9, SCS, and high IMT were related to the primary end point. Cox regression showed that peripheral arterial disease (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.18-3.59; P=0.011), SCS (HR, 3.02; 95% CI, 1.78-5.13; P=0.0001), and high IMT (HR, 1.86; 95% CI, 1.05-3.29; P=0.032) were related to the primary end point. If patients with scheduled revascularization procedures were excluded from the Cox regression, then ultrasonographic markers were SCS (HR, 1.84; 95% CI, 1.03-3.28; P<0.039) and high IMT (HR, 1.86; 95% CI, 1.06-3.27; P=0.030).
  
  
  CONCLUSIONS
  Both SCS and high IMT have an independent impact as markers of major cardiovascular events or death after a first-ever noncardioembolic stroke.
authors.affiliation: Neurology Department, Hospital Universitari del Mar, Passeig Marítim 25-29, 0003 Barcelona, Spain. jroquer@hospitaldelmar.cat
authors.forename: Jaume
authors.initials: J
authors.lastname: Roquer
authors.forename: Tomás
authors.initials: T
authors.lastname: Segura
authors.forename: Joaquín
authors.initials: J
authors.lastname: Serena
authors.forename: Elisa
authors.initials: E
authors.lastname: Cuadrado-Godia
authors.forename: Miguel
authors.initials: M
authors.lastname: Blanco
authors.forename: Jorge
authors.initials: J
authors.lastname: García-García
authors.forename: José
authors.initials: J
authors.lastname: Castillo
mesh_terms: D000368:Aged; D059168:Carotid Intima-Media Thickness / Q000592:standards*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D055502:Secondary Prevention; D020521:Stroke / Q000000981:diagnostic imaging* / Q000517:prevention & control