OBJECTIVE: We investigated carotid arterial mechanics using velocity vector imaging (VVI) in patients with stroke. METHODS: We evaluated 33 male patients (54 짹 8 years) with stoke and 28 healthy age-matched old (53 짹 8 years) and 21 healthy young (29 짹 5 years) male volunteers. Transverse images of right common carotid arteries (CCA) proximal to the bifurcation were obtained and divided into six segments. The peak circumferential strain and strain rate of the six segments and the standard deviation of the time to peak circumferential strain and strain rate of the six segments, representing the synchronicity of the arterial expansion, were calculated using VVI. RESULTS: In VVI analyses, averages of circumferential strain and strain rates were significantly decreased with ages, but patients with stroke had more decreased strain (3.4 짹 1.6 % vs 4.7 짹 1.8 %, p<0.01) and strain rate (0.23 짹 0.10 s- vs 0.35 짹 0.13 s-1, p<0.01) compared with healthy age-matched old volunteers. Carotid IMT did not provide incremental value over multiple clinical risk factors (diabetes mellitus, hypertension, coronary artery disease, smoking), but adding strain and strain rate assessed by VVI presented incremental value over multiple risk factors and carotid IMT for stroke (Figure). CONCLUSIONS: In patients with stroke, carotid arteries assessed with VVI exhibited more decreased arterial expansion during systole compared with age-matched healthy volunteers. Though carotid IMT did not provide incremental value over multiple clinical risk factors (diabetes mellitus, hypertension, coronary artery disease, smoking), adding strain and strain rate assessed by VVI presented incremental value over multiple risk factors and carotid IMT for stroke.