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Definition of common carotid wall thickness affects risk classification in relation to degree of internal carotid artery stenosis: the Plaque At RISK (PARISK) study
Authors:J Steinbuch  AC van Dijk  FHBM Schreuder  MTB Truijman  J Hendrikse  PJ Nederkoorn  A van der Lugt  E Hermeling  APG Hoeks  WH Mess
Institution:1.Biomedical Engineering, Cardiovascular Research Institute Maastricht,Maastricht University,Maastricht,The Netherlands;2.Radiology,Erasmus Medical Center,Rotterdam,The Netherlands;3.Neurology,Erasmus Medical Center,Rotterdam,The Netherlands;4.Radiology,Maastricht University Medical Center,Maastricht,The Netherlands;5.Clinical Neurophysiology,Maastricht University Medical Center,Maastricht,The Netherlands;6.Neurology,Maastricht University Medical Center,Maastricht,The Netherlands;7.Radiology,University Medical Center Utrecht,Utrecht,The Netherlands;8.Neurology,Academic Medical Center,Amsterdam,The Netherlands
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:
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