scholarly journals Plaque Contact Surface Area and Flow Lumen Volume Predict Stroke Risk in Extracranial Carotid Artery Stenosis

2021 ◽  
Author(s):  
Ryan Gedney ◽  
Ethan Kung ◽  
Veena Mehta ◽  
Adam Brown ◽  
Matthew Bridges ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Surface Area ◽  
Contact Surface ◽  
Carotid Artery Stenosis ◽  
Carotid Arteries ◽  
Stroke Risk ◽  
Artery Stenosis ◽  
Operating Characteristics ◽  
Contact Surface Area ◽  
Stroke Center

The standard indication for intervention in asymptomatic disease is currently percent stenosis in the internal carotid artery as measured by the NASCET method, which remains limited in discriminating power. CT angiography (CTA) is widely used to calculate NASCET stenosis but also offers the opportunity to analyze carotid artery plaques from a morphological perspective that has not been widely utilized. We aim to improve stroke risk stratification of patients with carotid artery stenosis using plaque 3D modeling and image analysis. Patients with CTAs appropriate for 3D reconstruction were identified from an NIH designated stroke center database, and carotid arteries were segmented and analyzed using software algorithms to calculate contact surface area between the plaque and blood flow (CSA), and volume of the flow lumen within the region of the plaque (FLV). These novel parameters factor in the 3D morphometry inherent to each carotid plaque. A total of 134 carotid arteries were analyzed, 33 of which were associated with an ipsilateral stroke. Plaques associated with stroke demonstrated statistically significant increases in average CSA and FLV when compared to those not associated with stroke. When compared to NASCET percent stenosis, CSA and FLV both demonstrated a larger area under the receiver operating characteristics curve (AUC) in predicting stroke risk in patients with carotid stenosis. The data presented here demonstrate morphological features of carotid plaques that are independent of NASCET criteria stratification and may present an improved method in assessing stroke risk in patients with carotid artery stenosis.

scholarly journals Clinical risk factors predictive of thrombotic stroke with large cerebral infarction

2019 ◽  
Vol 11 (2) ◽  
Author(s):  
Worapot Rojsanga ◽  
Kittisak Sawanyawisuth ◽  
Verajit Chotmongkol ◽  
Somsak Tiamkao ◽  
Kannikar Kongbonkiat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Artery Stenosis ◽  
Stroke Risk ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Stroke Risk Factors

Large cerebral infarctions have high morbidity and mortality. Patients with large cerebral infarctions may have recurrent ischemia as high as 8.1% within 7 days; highest among other types of strokes. Data regarding risk factors for large cerebral infarction in Asian populations are still scant. All adult (age ≥15 years old) patients with the diagnosis of thrombotic ischemic stroke who were treated at Srinagarind Hospital, Khon Kaen University, Thailand from January 2012 to December 2013 were studied. Large cerebral infarctions are defined by clinical criteria of having cerebral cortical impairment, brain stem or cerebellar dysfunction with infarction sizes of more than 1.5 cm. The association of various stroke risk factors and large infarction strokes were calculated using multiple logistic regression analysis. There were 276 thrombotic stroke patients who met the study criteria; classified as large cerebral infarctions in 59 patients (21.38%) and small cerebral infarctions in 217 patients (78.62%). Baseline characteristics and risk factors for stroke were comparable between both groups. The large cerebral infarction group had a significantly larger proportions of right internal carotid artery stenosis, plaques on the left side, left internal carotid artery stenosis, and internal carotid artery stenosis at any side than the small cerebral infarction group. Among various stroke risk factors, only internal carotid artery stenosis at any side was the only significant factor associated with large cerebral infarction with an adjusted odds ratio of 11.14 (95% CI: 3.46, 35.82). In conclusion, significant internal carotid artery stenosis is associated with large cerebral infarction.

scholarly journals Carotid Artery Stenosis: Comparison of 3D Time-of-Flight MR Angiography and Contrast-Enhanced MR Angiography at 3T

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Ivan Platzek ◽  
Dominik Sieron ◽  
Philipp Wiggermann ◽  
Michael Laniado
Keyword(s):  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Mr Angiography ◽  
Carotid Arteries ◽  
Time Of Flight ◽  
Internal Carotid Artery Stenosis ◽  
Artery Stenosis ◽  
Wilcoxon Test ◽  
Tof Mra ◽  
Contrast Enhanced

Purpose. The aim of this study was to assess the correlation of 3D time-of-flight MR angiography (TOF MRA) and contrast-enhanced MR angiography (CEMRA) for carotid artery stenosis evaluation at 3T.Material and Methods. Twenty-three patients (5 f, 18 m; mean age 61 y, age range 45–78 y) with internal carotid artery stenosis detected with ultrasonography were examined on a 3.0T MR system. The MR examination included both 3D TOF MRA and CEMRA of the carotid arteries. MR images were evaluated independently by two board-certified radiologists. Stenosis evaluation was based on a five-point scale. Stenosis grades determined by TOF and CEMRA were compared using Spearman’s rank correlation coefficient and the Wilcoxon test. Cohen’s Kappa was used to evaluate interrater reliability.Results. CEMRA detected stenosis in 24 (52%) of 46 carotids evaluated, while TOF detected stenosis in 27 (59%) of 46 carotids. TOF MRA yielded significantly higher results for stenosis grade in comparison to CEMRA (P=0.014). Interrater agreement was very good for both TOF MRA (κ=0.93) and CEMRA (κ=0.93).Conclusion. At 3T, 3D TOF MRA should not be used as replacement for contrast-enhanced MRA of the carotid arteries, as it results in significantly higher stenosis grades.

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