Carotid Hemodynamic Parameters Are Useful for Discriminating Between Atherothrombotic Infarction and Lacunar Infarction

Using ultrasound, we investigated whether carotid parameters differed among subtypes of ischemic stroke and evaluated the usefulness of these parameters in discriminating among subtypes. Patients with ischemic stroke admitted to Nippon Medical School Hospital were consecutively recruited and grouped into 3 subtypes based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification: cardioembolism (group CE), large-artery atherosclerosis (group LAA), and small-vessel occlusion (group SVO). All subjects underwent carotid ultrasonography to determine maximum intima-media thickness (IMT), maximum systolic velocity (Vmax), minimum diastolic velocity (Vmin), mean velocity, and pulsatility index (PI). Carotid parameters that differed among subtypes were statistically identified. A total of 138 patients were enrolled. Intergroup comparisons revealed that the Vmin of the affected side was significantly lower in group LAA than in group SVO (mean +/- SD, 0.12 +/- 0.05 m/s vs 0.15 +/- 0.05 m/s; P = .02) and the Vmin of the mean of both sides was lower in group LAA than in group SVO (0.12 +/- 0.04 vs 0.16 +/- 0.05; P = .03). Multivariate analysis showed that the PI of the affected side was a useful adjunct to discriminate between groups SVO and LAA (odds ratio = 2.94; P = .03, group SVO as control). Receiver operating characteristic curve analysis found that the Vrnin of the affected side was the most useful parameter for discriminating between group SVO and group LAA. The PI and the Vmin of the affected side were found to differ among stroke subtypes, and thus these may be useful parameters for discriminating among ischemic stroke subtypes.