Wall Irregularity Rather Than Intima-Media Thickness is Associated with Nearby Atherosclerosis

Graf, Iulia M.; Schreuder, Floris H.B.M.; Hameleers, Jeroen M.; Mess, Werner H.; Reneman, Robert S.; Hoeks, Arnold P.G.

doi:10.1016/j.ultrasmedbio.2008.12.016

« Previous Next »Ultrasound in Medicine and Biology
Volume 35, Issue 6 , Pages 955-961, June 2009

Wall Irregularity Rather Than Intima-Media Thickness is Associated with Nearby Atherosclerosis

Iulia M. Graf
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
Floris H.B.M. Schreuder
- Department of Clinical Neurophysiology, University Maastricht Medical Centre, Maastricht, The Netherlands
Jeroen M. Hameleers
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
Werner H. Mess
- Department of Clinical Neurophysiology, University Maastricht Medical Centre, Maastricht, The Netherlands
Robert S. Reneman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
Arnold P.G. Hoeks
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- Address correspondence to: Arnold P.G. Hoeks, Ph.D., Department of Biomedical Engineering, CARIM, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands.

Received 19 September 2008; received in revised form 12 December 2008; accepted 16 December 2008. published online 02 March 2009.

Abstract

In addition to intima-media thickness (IMT), IMT inhomogeneity may carry information about atherosclerosis progression. In 147 vascular diseased patients (mean 66 y, 48% male), we determined the carotid bulb stenosis degree based on local Doppler blood flow velocities. Common carotid artery (CCA) morphologic characteristics, i.e. IMT, IMT-inhomogeneity (intraregistration variation) and IMT uni- and bilateral intrasubject variation (ΔIMT), were measured using multiple M-mode. Associations of morphologic characteristics, stenosis degree and Framingham score were evaluated with Pearson correlation (r) and multiple regression analysis. The IMT distributions for subjects without and with stenosis were not similar. The stenosis degree score correlated significantly to unilateral (r=0.68) and bilateral ΔIMT (r=0.62), IMT (r=0.41) and IMT-inhomogeneity (r=0.45). The averaged IMT and IMT-inhomogeneity increased slightly for singular stenosis and abruptly for multiple stenoses. Mean uni- and bilateral ΔIMT per stenosis degree increased linearly with this degree, reaching a correlation close to 1 (r=0.98 and r=0.97). Interestingly, the majority of the subjects with a moderate to severe bulb stenosis exhibited a carotid IMT lower than the considered critical threshold of 0.9mm. In conclusion, although CCA is not prone to plaques, its morphologic characteristics are positively correlated with stenosis degree score and other risk scores. ΔIMT can be more reliable derived from inter-registration rather than from intra-registration variation. In the CCA, ΔIMT substantiates vascular alteration better than IMT. (E-mail: A.Hoeks@BF.Unimaas.nl)