Association Between Carotid Bulb Diaphragm and Ischemic Stroke in Young Afro-Caribbean Patients: A Population-Based Case-Control Study.
Carotid bulb diaphragm (CBD) has been described in young carotid ischemic stroke (CIS) patients, especially in blacks. However, the prevalence of CBD in CIS patients is unknown, and whether CBD is a risk factor for CIS remains unclear. We assessed the association between CBD and incident CIS in a population-based study.



We selected all young (<55 years) CIS patients from a 1-year population-based cohort study in the Afro-Caribbean population of Martinique in 2012. All patients had a comprehensive work-up including a computed tomographic angiography. We calculated CIS associated with ipsilateral CBD incidence with 95% confidence intervals using Poisson distribution. We then selected age- and sex-matched controls among young (<55 years) Afro-Caribbean stroke-free patients admitted for a road crash who routinely had computed tomographic angiography. Odds ratio (ORs) were calculated by conditional logistic regression adjusted for hypertension, dyslipidemia, diabetes and smoking.



CIS associated with ipsilateral CBD incidence was 3.8 per 100 000 person-years (95% confidence interval, 1.4-6.1). Prevalence of ipsilateral CBD was 23% in all CIS and 37% in undetermined CIS patients. When restricted to undetermined CIS, CBD prevalence was 24 times higher than that in controls (adjusted OR, 24.1; 95% confidence interval, 1.8-325.6).



CBD is associated with an increased risk of ipsilateral CIS in young Afro-Caribbean population.
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.). julien.joux@gmail.com.
Julien
J
Joux
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Marion
M
Boulanger
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Severine
S
Jeannin
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Nicolas
N
Chausson
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Jean-Luc
JL
Hennequin
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Vincent
V
Molinié
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Didier
D
Smadja
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Emmanuel
E
Touzé
From the Stroke Unit (J.J., S.J.), Department of Vascular Surgery (J.-L.H.), and Department of Cellular Pathology (V.M.), University Hospital of Martinique, French West Indies; Stroke Unit, Hospital sud francilien, Corbeil Essonnes, France (N.C., D.S.); Stroke Unit, University Hospital Pellegrin, Bordeaux, France (S.O.); and Université de Caen Normandie, Inserm U919, CHU Côte de Nacre, Caen France (M.B., E.T.).
Stephane
S
Olindo
D000328:Adult; D044383:Black People; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D017691:Caribbean Region; D002339:Carotid Arteries / Q000002:abnormalities* / Q000000981:diagnostic imaging; D002346:Carotid Sinus / Q000002:abnormalities* / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D015331:Cohort Studies; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*
angiography; case–control study; cohort study; diaphragm; stroke