Year: 2026 | Month: October | Volume: 16 | Issue: 10 | Pages: 105-127
DOI: https://doi.org/10.52403/ijhsr.20261012
Bilateral Common Carotid Intima-Media Thickness and Plaque Topography Across Ischemic Infarction, Transient Ischemic Attack, and Intracerebral Hemorrhage: A Multivariable Carotid Phenotyping Study
Ashis Kumar Saha1, Prasun Chatterjee2, Moyukh Mukherjee3
1Professor & Head, Department of Medicine, Jagannath Gupta Institute of Medical Sciences, Budge Budge, Kolkata
2Assistant Professor, Department of Medicine, Jagannath Gupta Institute of Medical Sciences, Budge Budge, Kolkata
3Post Graduate trainee, Department of Medicine, Jagannath Gupta Institute of Medical Sciences, Budge Budge, Kolkata
Corresponding Author: Ashis Kumar Saha
ABSTRACT
Introduction: Carotid intima-media thickness (cIMT) and focal plaque represent related but distinct markers of vascular injury. Their distribution across ischemic infarction (INF), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) may clarify differences in cerebrovascular phenotypes. Because conventional risk factors overlap substantially, integrated carotid phenotyping may provide useful mechanistic information beyond isolated vascular measurements.
Aims and objectives: To compare bilateral common carotid artery cIMT, inter-side asymmetry, plaque prevalence, laterality and topography across INF, TIA and ICH, and assess their independent association with clinical presentation.
Materials and methods: This hospital-based study included 443 patients with cerebrovascular presentations: 238 INF, 113 TIA and 92 ICH. All underwent neuroimaging, laboratory evaluation and carotid Doppler ultrasonography. Right, left, mean and maximum CCA-IMT, asymmetry and plaque characteristics were analyzed. Kruskal-Wallis and chi-square tests, multinomial logistic regression, restricted cubic splines, sensitivity analyses and AUROC assessment with 10-fold cross-validation were performed.
Results: Mean bilateral cIMT was similar in INF, TIA and ICH (1.10±0.23, 1.09±0.25 and 1.09±0.26 mm; P=0.751), with no significant difference in other cIMT measures. Among 374 patients with interpretable plaque coding, plaque prevalence was 60.6%, 42.6% and 57.1%, respectively (P=0.014), driven by INF versus TIA (Holm-adjusted P=0.011). Mean cIMT was not independently associated with INF or TIA versus ICH, but was associated with plaque presence (aOR 1.60 per SD, 95% CI 1.24-2.07; P<0.001). Cross-validated macro-AUROC was 0.485.
Conclusion: Diffuse carotid wall thickening did not discriminate cerebrovascular presentation, whereas focal plaque prevalence differed, particularly between infarction and TIA. cIMT remains a marker of underlying carotid atherosclerotic burden rather than a stand-alone classifier of presentation subtype.
Key words: Bilateral Common Carotid Intima-medial thickness, Ischemic infarction, Transient ischemic attack, Intracerebral hemorrhage, carotid phenotyping study.