Carotid plaque surface irregularity predicts ischemic stroke: The northern Manhattan study

Shyam Prabhakaran, Tatjana Rundek, Romel Ramas, Mitchell S V Elkind, Myunghee Cho Paik, Bernadette Boden-Albala, Ralph L Sacco

Research output: Contribution to journalArticle

145 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - There is scant population-based evidence regarding extracranial carotid plaque surface irregularity and ischemic stroke. Using a prospective cohort design, we evaluated the association of carotid plaque surface irregularity and the risk of ischemic stroke in a multiethnic population. METHODS - High-resolution B-mode ultrasound of the carotid arteries was performed in 1939 stroke-free subjects (mean age 69±10.0 years; 59% women; 53% Hispanic, 25% black, 22% white). Plaque was defined as a focal protrusion 50% greater than the surrounding area and localized along the extracranial carotid tree (internal carotid artery/bifurcation vs common carotid artery). Plaque surface was categorized as regular or irregular. Cox proportional hazard models were used to assess the association of surface characteristics and the risk of ischemic stroke. RESULTS - Among 1939 total subjects, carotid plaque was visualized in 56.3% (1 plaque: 21.6%, >1 plaque: 34.7%, irregular plaque: 5.5%). During a mean follow up of 6.2 years after ultrasound examination, 69 ischemic strokes occurred. Unadjusted cumulative 5-year risks of ischemic stroke were: 1.3%, 3.0%, and 8.5% for no plaque, regular plaque, and irregular plaque, respectively. After adjusting for demographics, traditional vascular risk factors, degree of stenosis, and plaque thickness, presence of irregular plaque (vs no plaque) was independently associated with ischemic stroke (Hazard ratio, 3.1; 95% CI, 1.1 to 8.5). CONCLUSIONS - The presence of irregular carotid plaque independently predicted ischemic stroke in a multiethnic cohort. Plaque surface irregularities assessed by B-mode ultrasonography may help identify intermediate- to high-risk individuals beyond their vascular risk assessed by the presence of traditional risk factors.

Original languageEnglish
Pages (from-to)2696-2701
Number of pages6
JournalStroke
Volume37
Issue number11
DOIs
StatePublished - Nov 1 2006
Externally publishedYes

Fingerprint

Stroke
Common Carotid Artery
Internal Carotid Artery
Carotid Arteries
Hispanic Americans
Proportional Hazards Models
Population
Blood Vessels
Ultrasonography
Pathologic Constriction
Demography

Keywords

  • Carotid artery
  • Irregular plaque
  • Stroke
  • Ultrasound

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Carotid plaque surface irregularity predicts ischemic stroke : The northern Manhattan study. / Prabhakaran, Shyam; Rundek, Tatjana; Ramas, Romel; Elkind, Mitchell S V; Paik, Myunghee Cho; Boden-Albala, Bernadette; Sacco, Ralph L.

In: Stroke, Vol. 37, No. 11, 01.11.2006, p. 2696-2701.

Research output: Contribution to journalArticle

Prabhakaran, Shyam ; Rundek, Tatjana ; Ramas, Romel ; Elkind, Mitchell S V ; Paik, Myunghee Cho ; Boden-Albala, Bernadette ; Sacco, Ralph L. / Carotid plaque surface irregularity predicts ischemic stroke : The northern Manhattan study. In: Stroke. 2006 ; Vol. 37, No. 11. pp. 2696-2701.
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abstract = "BACKGROUND AND PURPOSE - There is scant population-based evidence regarding extracranial carotid plaque surface irregularity and ischemic stroke. Using a prospective cohort design, we evaluated the association of carotid plaque surface irregularity and the risk of ischemic stroke in a multiethnic population. METHODS - High-resolution B-mode ultrasound of the carotid arteries was performed in 1939 stroke-free subjects (mean age 69±10.0 years; 59{\%} women; 53{\%} Hispanic, 25{\%} black, 22{\%} white). Plaque was defined as a focal protrusion 50{\%} greater than the surrounding area and localized along the extracranial carotid tree (internal carotid artery/bifurcation vs common carotid artery). Plaque surface was categorized as regular or irregular. Cox proportional hazard models were used to assess the association of surface characteristics and the risk of ischemic stroke. RESULTS - Among 1939 total subjects, carotid plaque was visualized in 56.3{\%} (1 plaque: 21.6{\%}, >1 plaque: 34.7{\%}, irregular plaque: 5.5{\%}). During a mean follow up of 6.2 years after ultrasound examination, 69 ischemic strokes occurred. Unadjusted cumulative 5-year risks of ischemic stroke were: 1.3{\%}, 3.0{\%}, and 8.5{\%} for no plaque, regular plaque, and irregular plaque, respectively. After adjusting for demographics, traditional vascular risk factors, degree of stenosis, and plaque thickness, presence of irregular plaque (vs no plaque) was independently associated with ischemic stroke (Hazard ratio, 3.1; 95{\%} CI, 1.1 to 8.5). CONCLUSIONS - The presence of irregular carotid plaque independently predicted ischemic stroke in a multiethnic cohort. Plaque surface irregularities assessed by B-mode ultrasonography may help identify intermediate- to high-risk individuals beyond their vascular risk assessed by the presence of traditional risk factors.",
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AU - Prabhakaran, Shyam

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AU - Elkind, Mitchell S V

AU - Paik, Myunghee Cho

AU - Boden-Albala, Bernadette

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N2 - BACKGROUND AND PURPOSE - There is scant population-based evidence regarding extracranial carotid plaque surface irregularity and ischemic stroke. Using a prospective cohort design, we evaluated the association of carotid plaque surface irregularity and the risk of ischemic stroke in a multiethnic population. METHODS - High-resolution B-mode ultrasound of the carotid arteries was performed in 1939 stroke-free subjects (mean age 69±10.0 years; 59% women; 53% Hispanic, 25% black, 22% white). Plaque was defined as a focal protrusion 50% greater than the surrounding area and localized along the extracranial carotid tree (internal carotid artery/bifurcation vs common carotid artery). Plaque surface was categorized as regular or irregular. Cox proportional hazard models were used to assess the association of surface characteristics and the risk of ischemic stroke. RESULTS - Among 1939 total subjects, carotid plaque was visualized in 56.3% (1 plaque: 21.6%, >1 plaque: 34.7%, irregular plaque: 5.5%). During a mean follow up of 6.2 years after ultrasound examination, 69 ischemic strokes occurred. Unadjusted cumulative 5-year risks of ischemic stroke were: 1.3%, 3.0%, and 8.5% for no plaque, regular plaque, and irregular plaque, respectively. After adjusting for demographics, traditional vascular risk factors, degree of stenosis, and plaque thickness, presence of irregular plaque (vs no plaque) was independently associated with ischemic stroke (Hazard ratio, 3.1; 95% CI, 1.1 to 8.5). CONCLUSIONS - The presence of irregular carotid plaque independently predicted ischemic stroke in a multiethnic cohort. Plaque surface irregularities assessed by B-mode ultrasonography may help identify intermediate- to high-risk individuals beyond their vascular risk assessed by the presence of traditional risk factors.

AB - BACKGROUND AND PURPOSE - There is scant population-based evidence regarding extracranial carotid plaque surface irregularity and ischemic stroke. Using a prospective cohort design, we evaluated the association of carotid plaque surface irregularity and the risk of ischemic stroke in a multiethnic population. METHODS - High-resolution B-mode ultrasound of the carotid arteries was performed in 1939 stroke-free subjects (mean age 69±10.0 years; 59% women; 53% Hispanic, 25% black, 22% white). Plaque was defined as a focal protrusion 50% greater than the surrounding area and localized along the extracranial carotid tree (internal carotid artery/bifurcation vs common carotid artery). Plaque surface was categorized as regular or irregular. Cox proportional hazard models were used to assess the association of surface characteristics and the risk of ischemic stroke. RESULTS - Among 1939 total subjects, carotid plaque was visualized in 56.3% (1 plaque: 21.6%, >1 plaque: 34.7%, irregular plaque: 5.5%). During a mean follow up of 6.2 years after ultrasound examination, 69 ischemic strokes occurred. Unadjusted cumulative 5-year risks of ischemic stroke were: 1.3%, 3.0%, and 8.5% for no plaque, regular plaque, and irregular plaque, respectively. After adjusting for demographics, traditional vascular risk factors, degree of stenosis, and plaque thickness, presence of irregular plaque (vs no plaque) was independently associated with ischemic stroke (Hazard ratio, 3.1; 95% CI, 1.1 to 8.5). CONCLUSIONS - The presence of irregular carotid plaque independently predicted ischemic stroke in a multiethnic cohort. Plaque surface irregularities assessed by B-mode ultrasonography may help identify intermediate- to high-risk individuals beyond their vascular risk assessed by the presence of traditional risk factors.

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