Common Carotid Artery Intima–Media Thickness and Intracranial Atherosclerotic Disease (ICAD) as Predictors of Short-Term Major Adverse Cardiovascular Events (MACE) in Non-Hemorrhagic Stroke
Ida Bagus Ananta Wijaya1*, Bagus Ari Pradnyana Dwi Sutanegara2, Kumara Tini3
Abstract
Background: Non-hemorrhagic stroke (NHS) is a leading cause of global morbidity and mortality, with intracranial atherosclerotic disease (ICAD) as an important etiology. Intima–media thickness (IMT) is widely used as an early marker of atherosclerosis in both cerebral and coronary circulation. However, evidence on IMT and ICAD as predictors of short-term major adverse cardiovascular events (MACE) after NHS, and their mutual relationship, remains limited and inconsistent. Objective: This study aimed to evaluate the ability of common carotid artery IMT and ICAD to predict 90-day MACE in NHS patients, to determine a reliable IMT cutoff, and to assess the association between IMT and ICAD in this population. Methods: This prospective cohort study enrolled NHS inpatients at RSUP Prof. dr. I.G.N.G. Ngoerah. IMT was measured at admission by carotid ultrasonography, and ICAD was assessed with angiography imaging according to the hospital’s clinical protocol. Patients were followed for 90 days for MACE. The optimal IMT cutoff was identified using receiver operating characteristic (ROC) analysis. Associations of IMT and ICAD with MACE, and IMT with ICAD, were tested using proportion comparisons. Survival was analyzed with Kaplan–Meier curves and the log-rank test. Independent predictors were identified using multivariable Cox regression and reported as adjusted hazard ratios (AHRs). Results: 52 patients were included in this study. The optimal IMT cutoff to predict MACE was 0.82 mm (AUC 0.717; sensitivity 72.7%; specificity 68.3%). On chi-square analysis, higher IMT (RR 3.9; 95% CI 1.17–13.14; p=0.014) and ICAD (RR 4.6; 95% CI 1.34–15.39; p=0.005) were associated with 90-day MACE. IMT was not significantly associated with ICAD (RR 1.64; 95% CI 0.80–3.33; p=0.172). In multivariable analysis, elevated IMT was an independent predictor of short-term MACE (AHR 13.10; 95% CI 1.03–166.93; p=0.047), whereas ICAD was not an independent risk factor after adjustment (AHR 5.06; 95% CI 0.76–33.68; p=0.094). Additional independent predictors were atrial fibrillation (AHR 20.81; p=0.008), NIHSS severity (AHR 6.99; p=0.040), left-ventricular ejection fraction (AHR 0.89 per 1%; p=0.007; protective), and leukocyte count (AHR 1.42 per 10⁹/L; p=0.028). Conclusion: IMT at admission is an independent predictor of 90-day MACE in NHS patients. ICAD shows clinical relevance but is not an independent risk factor after adjustment, likely due to the limited number of events and collinearity with other covariates. No significant association between IMT and ICAD was observed. These findings support IMT for early risk stratification and underline the need for larger studies to validate the role of ICAD as a short-term MACE risk factor in the NHS.
Keywords
intima-media thickness; intracranial atherosclerotic disease; major adverse cardiovascular events
Cite This Article
Wijaya, I. B. A., Sutanegara, B. A. P. D., Tini, K. (2025). Common Carotid Artery Intima–Media Thickness and Intracranial Atherosclerotic Disease (ICAD) as Predictors of Short-Term Major Adverse Cardiovascular Events (MACE) in Non-Hemorrhagic Stroke. International Journal of Scientific Advances (IJSCIA), Volume 6| Issue 6: Nov – Dec 2025, Pages 1048-1055 URL: https://www.ijscia.com/wp-content/uploads/2025/11/Volume6-Issue6-Nov-Dec-No.972-1048-1055.pdf
Volume 6 | Issue 6: Nov – Dec 2025
