Can carotid ultrasound predict the presence of complex atheromatosis of the aortic arch?
Keywords:
acute ischemic stroke, transoesophageal echocardiography, carotid ultrasound, complex atheromatosis of the aortic arch, high-risk carotid plaquesAbstract
Background: The diagnosis of complex atheromatosis of the aortic
arch, a potential source of cerebral emboli, is made by transoesophageal echocardiography (TEE). Although a correlation has been
found between carotid and aortic atherosclerosis, it is not known
how reliably the results of the carotid ultrasound evaluation can
predict the presence of atheromatosis of the aortic arch.
Methods: We prospectively studied all patients referred to our
laboratory simultaneously for TEE and carotid ultrasound, with the
diagnosis of acute ischemic CVA. We evaluated the capacity of an
increased carotid intimal-media thickness (IMT) or the presence of
carotid high-risk atherosclerotic plaques to predict the presence
of complex atheromatosis of the aortic arc.
Results: A total of 101 ischemic stroke patients were sent to
our laboratory for TEE and carotid ultrasound. Considering the
presence of complex atheromatosis of the aortic arch as the
dependent variable, increased carotid IMT had a sensitivity of
42% and a specificity of 78% (positive predictive value 41%,
negative predictive value 80%), and carotid high-risk plaques had
a sensitivity of 22% and a specificity of 95% (positive predictive
value 60%, negative predictive value 77%).
Conclusions: In this study, a carotid ultrasound scan with an
abnormal IMT or high-risk plaques had a high specificity for the
presence of complex atheromatosis of the aortic arch, with a
low sensitivity.
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