J Clin Neurol.  2013 Oct;9(4):231-236. 10.3988/jcn.2013.9.4.231.

The Response of Carotid Intima-Media Thickness to Medical Treatment Is Correlated with That of Intracranial Atherosclerosis

Affiliations
  • 1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
  • 2Department of Neurology, Inha University Hospital, Incheon, Korea. jhrha@inha.ac.kr
  • 3Department of Neurology, Dongguk University Hospital, Goyang, Korea.
  • 4Department of Neurology, Konkuk University Hospital, Seoul, Korea.
  • 5Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, Korea.
  • 6Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

BACKGROUND AND PURPOSE
Intracranial atherosclerotic stenosis (ICAS) is considered as a major cause of stroke. The carotid intima-media thickness (CIMT), which accurately reflects the burden of generalized atherosclerosis, is also associated with stroke. The aim of this study was to determine the association between the CIMT and ICAS responses to medical treatment.
METHODS
This study constituted part of the "Trial of cilostazol in symptomatic intracranial arterial stenosis"-2 that evaluated the ICAS response after randomized antiplatelet treatment. Magnetic resonance angiography and CIMT measurement were performed at baseline and after 7 months of treatment. CIMT was measured using semiautomated software, and was presented as maximum (CIMT-max) and average (CIMT-ave) values. The change in CIMT was compared relative to the ICAS response (i.e., progression, no-change, and regression). Ordinal logistic regression and analysis of covariance (ANCOVA) were used to analyze the association between the responses.
RESULTS
Among the 101 enrolled patients, 85 underwent follow-up CIMT measurement. CIMT increased most in the ICAS progression group (CIMT-max: 0.09+/-0.23, CIMT-ave: 0.04+/-0.12), and to a lesser degree in the no-change group (CIMT-max: 0.02+/-0.16, CIMT-ave: 0.02+/-0.11), but decreased in patients with ICAS regression (CIMT-max: -0.04+/-0.11, CIMT-ave: -0.03+/-0.07; CIMT-max: p=0.010, CIMT-ave: p=0.015). Ordinal logistic regression analysis demonstrated that the change in CIMT-max was independently associated with the ICAS response (p=0.032). However, the ANCOVA revealed that the reverse was not true, in that the ICAS response was not independently associated with the change in CIMT after adjusting for confounding factors.
CONCLUSIONS
The ICAS response may be associated with the CIMT response to medical treatment.

Keyword

carotid intima media thickness; intracranial atherosclerosis; antiplatelet

MeSH Terms

Atherosclerosis
Carotid Intima-Media Thickness*
Constriction, Pathologic
Follow-Up Studies
Humans
Intracranial Arteriosclerosis*
Logistic Models
Magnetic Resonance Angiography
Stroke
Tetrazoles
Tetrazoles

Figure

  • Fig. 1 Difference in CIMT change relative to the ICAS response after treatment of symptomatic ICAS. CIMT: carotid intima-media thickness, ICAS: intracranial atherosclerotic stenosis.


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