Higher Carotid Intima Media Thickness Predicts Extracranial Vascular Events and Not Stroke Recurrence among Transient Ischemic Attack Patients

Abstract

Background Increased common carotid artery intima-media thickness has been associated with an increased risk of vascular ischemic events. We investigated the relationship between common carotid artery intima-media thickness and extracranial vascular events (coronary heart disease and peripheral arterial disease) or stroke recurrence in a cohort of transient ischemic attack patients from the REGITELL registry. Methods High-resolution B-mode ultrasonographic measurements of the common carotid artery intima-media thickness were performed in a series of 283 consecutive transient ischemic attack patients. Clinical, neuroimaging, ultrasonographic, and etiological data were collected. Patients were followed prospectively for six-months or more. Extracranial vascular events and stroke recurrence were recorded. Results Fifteen extracranial vascular events (12 coronary heart disease and three peripheral arterial disease) and 29 recurrent strokes occurred during a median follow-up period of 12·3 months. Patients who experienced extracranial vascular events had significantly ( P < 0·001) higher common carotid artery intima-media thickness values (1·087 (standard deviation 0·189) mm) than subjects who were free of extracranial vascular events (0·887 (standard deviation 0·195) mm). Nevertheless, common carotid artery intima-media thickness was not found to correlate with stroke recurrence. Cox proportional hazards multivariate analyses identified hypercholesterolemia (hazard ratio 6·87, 95% confidence interval: 1·93–24·39, P = 0·003) and common carotid artery intima-media thickness >0·939 mm (hazard ratio 8·90, 95% confidence interval: 2·00–39·49, P = 0·004) as independent predictors of extracranial vascular events after transient ischemic attack. Almost one of every three patients with hypercholesterolemia and high common carotid artery intima-media thickness had extracranial vascular events. Conclusions An elevated common carotid artery intima-media thickness value was associated with a higher long-term risk of extracranial vascular events but no with stroke recurrence. Hypercholesterolemia was the main risk factor for extracranial vascular events. The combination of hypercholesterolemia and common carotid artery intima-media thickness >0·939 mm justify the establishment of aggressive therapies and the study of subclinical coronary heart disease and peripheral arterial disease.