Implication of Earlier Carotid Atherosclerosis for Stroke and Its Subtypes

Yoji Nagai, MD, PhD, Kazuo Kitagawa, MD, PhD, Masayasu Matsumoto, MD, PhD


Prev Cardiol. 2003;6(2) 

In This Article

Abstract and Introduction

In addition to advanced stenosis, earlier stages of carotid atherosclerosis are associated with the risk for stroke. Based on a recent report, this review will focus on the associations between carotid atherosclerosis and stroke subtypes. The authors report increased severity of carotid atherosclerosis in atherothrombotic and lacunar infarction patients, compared to nonstroke patients. However, the severity was similar between nonstroke patients and those with cardioembolic infarction and cerebral hemorrhage. By receiver operating characteristic curve analyses, although evaluation of carotid atherosclerosis appears to help for risk assessment of atherothrombotic and lacunar infarction, the potential for benefit may be greater for atherothrombotic. Large prospective studies are still necessary to establish the link between earlier carotid atherosclerosis and the future risk for specific stroke subtypes.

Ultrasound has allowed for noninvasive observation of atherosclerosis in the carotid arteries. If the initial manifestation begins with minor changes in wall thickness, then focal plaque formation, and subsequent encroachment into the lumen represent later stages.[1] Although many studies, including ours,[2] have shown associations of carotid atherosclerosis with coronary artery disease, data relating it to stroke have been limited.[3,4,5] Moreover, stroke is a heterogeneous disease with different etiologies, in which atherosclerosis does not always play a direct role. Consequently, the implication of carotid atherosclerosis remains to be established for respective stroke subtypes. This review focuses on the associations of carotid atherosclerosis with stroke and its subtypes.