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Observational Study
. 2017 Apr 4;15(1):9.
doi: 10.1186/s12947-017-0097-4.

Definition of common carotid wall thickness affects risk classification in relation to degree of internal carotid artery stenosis: the Plaque At RISK (PARISK) study

J Steinbuch  1 , A C van Dijk  2   3 , Fhbm Schreuder  4   5   6 , Mtb Truijman  4   5   6 , J Hendrikse  7 , P J Nederkoorn  8 , A van der Lugt  2 , E Hermeling  4 , Apg Hoeks  1 , W H Mess  9
Affiliations
Observational Study

Definition of common carotid wall thickness affects risk classification in relation to degree of internal carotid artery stenosis: the Plaque At RISK (PARISK) study

J Steinbuch et al. Cardiovasc Ultrasound. .

Abstract

Background: Mean or maximal intima-media thickness (IMT) is commonly used as surrogate endpoint in intervention studies. However, the effect of normalization by surrounding or median IMT or by diameter is unknown. In addition, it is unclear whether IMT inhomogeneity is a useful predictor beyond common wall parameters like maximal wall thickness, either absolute or normalized to IMT or lumen size. We investigated the interrelationship of common carotid artery (CCA) thickness parameters and their association with the ipsilateral internal carotid artery (ICA) stenosis degree.

Methods: CCA thickness parameters were extracted by edge detection applied to ultrasound B-mode recordings of 240 patients. Degree of ICA stenosis was determined from CT angiography.

Results: Normalization of maximal CCA wall thickness to median IMT leads to large variations. Higher CCA thickness parameter values are associated with a higher degree of ipsilateral ICA stenosis (p < 0.001), though IMT inhomogeneity does not provide extra information. When the ratio of wall thickness and diameter instead of absolute maximal wall thickness is used as risk marker for having moderate ipsilateral ICA stenosis (>50%), 55 arteries (15%) are reclassified to another risk category.

Conclusions: It is more reasonable to normalize maximal wall thickness to end-diastolic diameter rather than to IMT, affecting risk classification and suggesting modification of the Mannheim criteria.

Trial registration: Clinical trials.gov NCT01208025 .

Keywords: Atherosclerosis; Carotid IMT; Carotid artery imaging; Stenosis; Ultrasound.

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Figures

Fig. 1
Fig. 1
Absolute maximal wall thickness, thickness-to-diameter ratio and thickness-to-IMT ratio of the CCA as function of the presence of CCA plaque. Values are presented as normal z-scores, based on the mean and SD of the thickness parameters for arteries without CCA plaques. Arteries with CCA plaques clearly have a significantly larger wall thickness. Normalized thickness-to-IMT has a wider distribution than maximal wall thickness and thickness-to-diameter ratio
Fig. 2
Fig. 2
Absolute maximal wall thickness as function of absolute IMT inhomogeneity (left) and thickness-to-diameter ratio as function of relative IMT inhomogeneity (right). A strong correlation exists between absolute maximal wall thickness and absolute IMT inhomogeneity (R = 0.76) and between thickness-to-diameter ratio and relative IMT inhomogeneity (R = 0.73)
Fig. 3
Fig. 3
ROC curve for absolute maximal wall thickness (black line), thickness-to-diameter ratio (grey line) and thickness-to-IMT ratio (dotted line) for determination of a >50% ipsilateral ICA stenosis. Optimal cut-off values with the shortest distance (0.60, 0.61 and 0.64, respectively) towards the left upper corner are 1277 μm for absolute maximal wall thickness, 17% for thickness-to-diameter ratio and 129% for thickness-to-IMT ratio
Fig. 4
Fig. 4
Absolute maximal wall thickness of the CCA as function of degree of ipsilateral ICA stenosis. Patients with absolute maximal wall thickness below the ROC defined cut-off (dashed line) have a wide range of plaque sizes whereas patients with absolute maximal wall thickness above the ROC defined cut-off have larger degree of ICA stenosis
See this image and copyright information in PMC

References

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