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The prevalence of normal common carotid artery IMT in patients with carotid plaque.

EuroPRevent 2011  
Doctor Murray Matangi (EUD ID : 32405)
Kingston Heart Clinic
Cardiology Dept.
460 Princess Street
K7L 1C2 - Kingston Canada
Phone : +1 6135443242 - Fax : +1 6135464487
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
  Agreement Form sent on 16/12/2010 03:11
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Title : The prevalence of normal common carotid artery IMT in patients with carotid plaque.
Topic : 01.08 - Atherosclerosis/CAD (Prevention & Epidemiology)
Category : Not Member of EACPR
Option : No Options
M. Matangi1, A. Dillon1, D. Armstrong1, U. Jurt1, D. Brouillard1 - (1) Kingston Heart Clinic, Kingston, Canada
Purpose. Much has been made about the measurement of IMT in the distal common carotid artery (CCA) and its ability to predict patients at increased risk for future cardiovascular events. It has been our impression that there are many patients with carotid plaque either in the carotid bulb, the internal carotid artery (ICA) or the external carotid artery (ECA) who have a normal CCA IMT. The purpose of our investigation was to assess the prevalence of a normal CCA IMT in patients with carotid plaque. 
Methods. CAROTIDfile, the carotid duplex imaging module of CARDIOfile our cardiology database and reporting system was searched for all patients with an ICA stenosis of 1-39% or greater. Carotid stenoses were defined using established ICAVL imaging and velocity criteria. Carotid disease could be bilateral or unilateral. We then looked at the CCA IMT values for these patients. A normal CCA IMT was deemed to be present when both the R) and L) CCA IMT were <1.00mm. 
Results. See Table 1.
Conclusion. In patients with carotid plaque in the ICA, ECA or carotid bulb, 38.5% have normal CCA IMT in both common carotid arteries. It is clear that by focusing only on CCA IMT one misses the bigger picture, which is clear evidence of atherosclerosis, indicating increased cardiovascular risk. We believe there should be a paradigm shift away from CCA IMT towards carotid plaque.
Table 1.
 

N

%

Total

2291

100

Bilateral plaque

1708

74.6

Unilateral plaque

583

25.4

IMT ≤1.00mm in both CCA

883

38.5

ICAVL stenosis*

R) carotid

L) carotid

Normal**

296

287

1-39%

1396

1342

40-59%

461

509

60-79%

87

92

80-95%

38

40

95-99%

2

2

100%

11

19

NB: *ICAVL = Intersocietal commission for accredited vascular laboratories. **The normal on one side are abnormal by ICAVL on the other.