Association Between Calcification of the Cervical Carotid Artery Bifurcation and White Matter Ischemia

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2006 Feb 18

PMID 16484414

Citations 18

Authors

N F Fanning

T D Walters

A J Fox

S P Symons

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The association of cervical carotid artery bifurcation calcification to future stroke risk is unknown, though coronary artery calcification is a proven indicator of heart disease risk. Severity of white matter change has been correlated with future stroke risk. We sought to use white matter severity grade on CT as a surrogate predictor of relative future stroke risk and thus correlate white matter and future stroke risk with carotid calcification grade.

Methods: We retrospectively reviewed unenhanced neck and brain CTs in 209 patients. Carotid calcification degree was scored by the Agatston method, adapted from that commonly used to quantify coronary artery calcification. White matter change severity was scored by the European Task Force for Age-Related White Matter Change scale. Both scores were measured blinded to each other, and to age and sex covariables. Association was tested by univariate and multivariate analyses.

Results: Both carotid calcification and white matter scores were strongly, and independently, associated with increasing age (r = 0.61, P < .001; and r = 0.67, P < .001, respectively). Despite apparent association between carotid calcification and white matter scores on univariate analysis, there was no independent effect evident after adjusting for age as a covariant (r = 0.07, P = .14). Sex had no independent effect on white matter scores, though men had a marginally higher mean calcified carotid plaque load than women after controlling for age (P = .008).

Conclusions: Carotid calcification scores do not independently predict severity of white matter ischemia. Future stroke risk, assessed by white matter severity scores, cannot be predicted from carotid calcium scores.

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References

Jeerakathil T, Wolf P, Beiser A, Massaro J, Seshadri S, DAgostino R . Stroke risk profile predicts white matter hyperintensity volume: the Framingham Study. Stroke. 2004; 35(8):1857-61. DOI: 10.1161/01.STR.0000135226.53499.85. View

Greenland P, Smith Jr S, Grundy S . Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation. 2001; 104(15):1863-7. DOI: 10.1161/hc4201.097189. View

Pletcher M, Tice J, Pignone M, Browner W . Using the coronary artery calcium score to predict coronary heart disease events: a systematic review and meta-analysis. Arch Intern Med. 2004; 164(12):1285-92. DOI: 10.1001/archinte.164.12.1285. View

Shaalan W, Cheng H, Gewertz B, McKinsey J, Schwartz L, Katz D . Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. J Vasc Surg. 2004; 40(2):262-9. DOI: 10.1016/j.jvs.2004.04.025. View

Vermeer S, Hollander M, van Dijk E, Hofman A, Koudstaal P, Breteler M . Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam Scan Study. Stroke. 2003; 34(5):1126-9. DOI: 10.1161/01.STR.0000068408.82115.D2. View

Breteler M, van Swieten J, Bots M, Grobbee D, Claus J, van den Hout J . Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study. Neurology. 1994; 44(7):1246-52. DOI: 10.1212/wnl.44.7.1246. View

Hollander M, Hak A, Koudstaal P, Bots M, Grobbee D, Hofman A . Comparison between measures of atherosclerosis and risk of stroke: the Rotterdam Study. Stroke. 2003; 34(10):2367-72. DOI: 10.1161/01.STR.0000091393.32060.0E. View

Mathiesen E, Bonaa K, Joakimsen O . Echolucent plaques are associated with high risk of ischemic cerebrovascular events in carotid stenosis: the tromsø study. Circulation. 2001; 103(17):2171-5. DOI: 10.1161/01.cir.103.17.2171. View

. Predictors of major vascular events in patients with a transient ischemic attack or nondisabling stroke. The Dutch TIA Trial Study Group. Stroke. 1993; 24(4):527-31. DOI: 10.1161/01.str.24.4.527. View

10.

Nandalur K, Baskurt E, Hagspiel K, Phillips C, Kramer C . Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. AJR Am J Roentgenol. 2004; 184(1):295-8. PMC: 2955331. DOI: 10.2214/ajr.184.1.01840295. View

11.

Belcaro G, Laurora G, Cesarone M, De Sanctis M, Incandela L, Fascetti E . Ultrasonic classification of carotid plaques causing less than 60% stenosis according to ultrasound morphology and events. J Cardiovasc Surg (Torino). 1993; 34(4):287-94. View

12.

Hoffmann U, Kwait D, Handwerker J, Chan R, LaMuraglia G, Brady T . Vascular calcification in ex vivo carotid specimens: precision and accuracy of measurements with multi-detector row CT. Radiology. 2003; 229(2):375-81. DOI: 10.1148/radiol.2292021016. View

13.

. North American Symptomatic Carotid Endarterectomy Trial. Methods, patient characteristics, and progress. Stroke. 1991; 22(6):711-20. DOI: 10.1161/01.str.22.6.711. View

14.

Hunt J, Fairman R, Mitchell M, Carpenter J, Golden M, Khalapyan T . Bone formation in carotid plaques: a clinicopathological study. Stroke. 2002; 33(5):1214-9. DOI: 10.1161/01.str.0000013741.41309.67. View

15.

Kitamura A, Iso H, Imano H, Ohira T, Okada T, Sato S . Carotid intima-media thickness and plaque characteristics as a risk factor for stroke in Japanese elderly men. Stroke. 2004; 35(12):2788-94. DOI: 10.1161/01.STR.0000147723.52033.9e. View

16.

Kuller L, Longstreth Jr W, Arnold A, Bernick C, Bryan R, Beauchamp Jr N . White matter hyperintensity on cranial magnetic resonance imaging: a predictor of stroke. Stroke. 2004; 35(8):1821-5. DOI: 10.1161/01.STR.0000132193.35955.69. View

17.

Babiarz L, Yousem D, Wasserman B, Wu C, Bilker W, Beauchamp Jr N . Cavernous carotid artery calcification and white matter ischemia. AJNR Am J Neuroradiol. 2003; 24(5):872-7. PMC: 7975766. View

18.

Denzel C, Lell M, Maak M, Hockl M, Balzer K, Muller K . Carotid artery calcium: accuracy of a calcium score by computed tomography-an in vitro study with comparison to sonography and histology. Eur J Vasc Endovasc Surg. 2004; 28(2):214-20. DOI: 10.1016/j.ejvs.2004.05.004. View

19.

Gronholdt M, Nordestgaard B, Schroeder T, Vorstrup S, Sillesen H . Ultrasonic echolucent carotid plaques predict future strokes. Circulation. 2001; 104(1):68-73. DOI: 10.1161/hc2601.091704. View

20.

Naghavi M, Libby P, Falk E, Casscells S, Litovsky S, Rumberger J . From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation. 2003; 108(14):1664-72. DOI: 10.1161/01.CIR.0000087480.94275.97. View