T. Rundek
Miller School of Medicine University of Miami – Miami, USA
Carotid atherosclerotic disease plays a large role in the etiology of stroke. B-mode carotid ultrasound has been widely used to detect subclinical carotid atherosclerosis by quantifying carotid intima–media thickness (cIMT) and carotid plaque (CP). Both cIMT and CP have been accepted surrogate imaging biomarkers of subclinical atherosclerosis until recently when it became increasingly clear that cIMT and CP may be genetically and biologically distinct atherosclerotic phenotypes with evidence of heterogeneous etiology. In addition, carotid atherosclerotic plaque burden, defined as the
NEUROSONOLOGY AND CEREBRAL HEMODYNAMICS, Volume 9, Number 2, 2013
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two-dimensional total plaque area (TPA) or tree-dimensional total plaque volume is a powerful non-invasive imaging tool for vascular risk estimation and stronger predictors for future ischemic stroke than cIMT.
cIMT and CP have been associated with prevalent and incident atherosclerotic disease with variable effects. Whether cIMT and CP are distinct phenotypes or represent a single trait at a different stage of atherosclerotic lesion development is unclear. cIMT may represent adaptive changes to increased shear stress with aging and it may not be an indicator of atherosclerotic therefore the pathophysiological significance of arterial wall thickening with regard to transformation into plaque is questionable. Experimental and epidemiological studies have not yet clarified this dilemma. This presentation will discuss adaptive changes in the arterial wall with aging and how these changes are related to the development of atherosclerosis. The cross-sectional and prospective relationships between cIMT and plaque phenotypes (plaque thickness and area) will be presented using data from in an urban multi-ethnic stroke-free population of northern Manhattan.
Key words: carotid atherosclerosis, carotid IMT, carotid plaque.