Expansive carotid artery remodeling: possible marker of vulnerable plaque

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  • 1 Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and
  • 2 Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan
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OBJECTIVE

Accumulated findings in the pathophysiology of atherosclerosis have demonstrated that not only luminal narrowing but also plaque characteristics influence the risk of future ischemic events. The morphology of the carotid artery (CA) changes in response to atherosclerotic development by expansive remodeling (ER), the clinical significance of which remains unclear. This study aimed to define associations between ER and local risk factors, including CA geometry and traditional systemic risk factors for ischemic events, to determine whether ER could serve as a clinical marker of carotid vulnerable plaque.

METHODS

The authors retrospectively analyzed 66 patients with CA stenosis who were scheduled to undergo carotid endarterectomy or CA stenting. They calculated ER ratios in the internal CA (ICA) from long-axis MR images and as the maximal distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA/the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis. Relative overall signal intensity (roSI) was calculated to assess intraplaque hemorrhage and defined as the signal intensity of plaque on an axial T1-weighted image with maximal stenosis relative to that of the adjacent sternocleidomastoid muscle. The authors evaluated CA geometry by calculating the angles between the common CA (CCA) and ICA, and between the CCA and external CA (ECA) using digital subtraction angiography. The ER ratios, age, sex, percentage of stenosis, roSI, hypertension, hyperlipidemia, low-density lipoprotein, statin medication, diabetes, smoking habit, and ischemic heart disease were compared between 33 symptomatic and 33 asymptomatic patients. The authors also compared symptomatic status, age, sex, percentage of stenosis, ICA angle, ECA angle, roSI, and other traditional atherosclerotic risk factors between groups with extensive and slight ER.

RESULTS

The ER ratio was significantly greater in symptomatic than in asymptomatic patients (1.91 ± 0.46 vs 1.68 ± 0.40, p < 0.05). The ICA angle was significantly larger in the group with extensive ER than in those with slight ER (33.9° ± 20.2° vs 21.7° ± 13.8°, p < 0.01). The roSI, ECA angle, percentage stenosis, or any other traditional vascular risk factors were not associated with ER.

CONCLUSIONS

Carotid ER might be an independent indicator of carotid vulnerable plaque, which should be validated in a longitudinal study of patients with carotid atherosclerosis, including those with nonstenotic to moderate stenosis.

ABBREVIATIONS CA = carotid artery; CAS = CA stenting; CCA = common CA; CEA = carotid endarterectomy; DSA = digital subtraction angiography; ECA = external CA; EER = extensive ER; ER = expansive remodeling; ICA = internal CA; IPH = intraplaque hemorrhage; LDL = low-density lipoprotein; NASCET = North American Symptomatic Carotid Endarterectomy Trial; NR = negative remodeling; roSI = relative overall signal intensity; SER = slight ER.

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Contributor Notes

Correspondence Kazumichi Yoshida: Kyoto University Graduate School of Medicine, Kyoto, Japan. kazuy@kuhp.kyoto-u.ac.jp.

INCLUDE WHEN CITING Published online October 4, 2019; DOI: 10.3171/2019.7.JNS19727.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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