title: Bilateral common carotid artery ultrasound for prediction of incident strokes using intima-media thickness and external diameter: an observational study.
abstract: BACKGROUND
  External common carotid artery (CCA) diameter and intima-media thickness (IMT) are independently associated with incident stroke and other cardiovascular events. Arterial geometry such as large IMT and large diameter may reflect vulnerable plaques and so impact stroke risk. Finally, arterial changes that exist bilaterally may increase stroke risk.
  
  
  METHODS
  We studied middle-aged men and women (n=7276) from a prospective observational study who had right (R) and left (L) CCA IMT and external diameters measured via B-mode ultrasound (1987-89) in order to categorize CCA geometry. Using side- and gender-specific IMT and diameter medians, we categorized each measurement as large (≥ median) vs. not large (< median) and defined four geometries: both IMT and diameter were large, only one parameter was large, or neither was large (reference group). Participants were followed for first time stroke through December 31, 1999. We used proportional hazards models to assess associations between right and left CCA geometries with new stroke. We also calculated positive and negative likelihood ratios (+LR and -LR) for CCA bilateral phenotypes as a measure of diagnostic accuracy.
  
  
  RESULTS
  Presence of both large CCA IMT and large diameter on one side was associated with strong stroke risk even after risk factor adjustment (men: RCCA hazard ratio [HR]=3.7 95% confidence interval [CI]=1.9-7.4; LCCA HR=2.4 95% CI=1.4-4.4; women: RCCA HR=4.0 95% CI=1.5-10.5; LCCA HR=5.7 95% CI=1.7-19.0). Presence of both large IMT and large diameter bilaterally was the strongest predictor of stroke identifying 64% of women and 44% of men who developed strokes. This phenotype showed potential for predicting stroke among individuals (women: +LR=3.1, 95% CI=2.6-3.8; men: +LR=2.3, 95% CI=1.8-2.8).
  
  
  CONCLUSIONS
  Bilateral carotid artery geometries may be useful for stroke risk prediction.
authors.affiliation: College of Medicine and Fay W, Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA. meigenbrodt@gmail.com
authors.forename: Marsha L
authors.initials: ML
authors.lastname: Eigenbrodt
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Evans
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Rose
authors.forename: Zoran
authors.initials: Z
authors.lastname: Bursac
authors.forename: Richard E
authors.initials: RE
authors.lastname: Tracy
authors.forename: Jawahar L
authors.initials: JL
authors.lastname: Mehta
authors.forename: David J
authors.initials: DJ
authors.lastname: Couper
mesh_terms: D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology