According to a new study published in the Journal of Neurology, ultrasound measurement of intima-media thickness (IMT) in the common carotid artery (CCA) can help distinguish between lacunar infarction (LI) and intracerebral hemorrhage (ICH), among hypertensive stroke patients.
Lead author, Dr G Tsivgoulis, University of Athens "Eginition" Hospital, Greece, said, "Arterial hypertension is the major risk factor for ICH and LI, and both types of cerebral lesions originate from pathology of the same deep perforating small arteries." Therefore, identifying factors that could differentiate between the two conditions would be of diagnostic value.
To determine whether vascular risk factors such as CCA-IMT differ between patients with ICH and those with LI, Tsivgoulis and colleagues studied 159 stroke patients with a documented history of hypertension, 67 of whom had suffered ICH, while 92 had experienced LI. Participants underwent ultrasonographic measurement of CCA-IMT, and information on vascular risk factors, severity and duration of hypertension, and concomitant medication use was also collected.
The study showed that patients with LI had significantly larger CCA-IMT values than those with ICH, with an average thickness of 0.926mm and 0.815mm, respectively. This difference persisted even after taking baseline characteristics and cardiovascular medication use into account. The difference increased continuously with CCA-IMT, with each 0.1mm increase in IMT conferring a 36.6% rise in the risk of LI versus ICH. Multivariate analysis showed that CCA-IMT, diabetes and hypercholesterolemia were all independent factors able to discriminate between LI and ICH.
"Increased CCA-IMT values are a factor favouring LI over ICH in hypertensive patients. The measurement of CCA-IMT may be a useful non-invasive diagnostic tool for the risk assessment of LI with respect to ICH in such patients," they conclude.
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