Increased carotid intima-media thickness in patients with ischaemic stroke is associated with systemic endothelial dysfunction and preclinical occlusive vascular disease

Background: Increased carotid intima-media thickness (IMT) reflects early atherosclerosis of supra-aortic arteries and may predict myocardial infarction and stroke. Decreased flow-mediated dilation (FMD) of the brachial artery and a pathologically low ankle brachial index (ABI) have been shown to be sensitive surrogate markers of systemic endothelial dysfunction and preclinical occlusive vascular disease. We aimed to evaluate whether increased levels of IMT in patients with recent ischaemic cerebral events of different subtypes is associated with systemic atherosclerosis as evaluated with FMD and ABI.

Methods: We prospectively assessed IMT, FMD, and ABI in 167 consecutive patients with recent ischaemic cerebral events due to cardioembolism (CE), small-artery occlusion, or large-artery atherosclerosis (LAA).

Results: IMT was increased (1.36±0.51mm) above normal values without significant differences between stroke subtypes. Mean ABI ranged around the lower cut-off level (0.94±0.18) but was significantly decreased in LAA (0.77±0.15) as compared to CE (1.03±0.14; p<0.001). Irrespective of stroke subtypes, both FMD and ABI were inversely correlated with IMT (-0.32, p<0.001; -0.28, p<0.05).

Conclusion: Increased levels of IMT in patients with ischaemic cerebral events are associated with systemic endothelial dysfunction and preclinical occlusive vascular disease irrespective of stroke subtypes.