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Carotid geometry is an independent predictor of wall thickness – a 3D cardiovascular magnetic resonance study in patients with high cardiovascular risk

Authors
  • Strecker, Christoph1
  • Krafft, Axel Joachim2
  • Kaufhold, Lilli3, 4
  • Hüllebrandt, Markus3, 4
  • Weber, Susanne2
  • Ludwig, Ute2
  • Wolkewitz, Martin2
  • Hennemuth, Anja3, 4
  • Hennig, Jürgen2
  • Harloff, Andreas1
  • 1 University of Freiburg, Breisacherstrasse 64, Freiburg, 79106, Germany , Freiburg (Germany)
  • 2 University of Freiburg, Freiburg, Germany , Freiburg (Germany)
  • 3 Fraunhofer MEVIS, Bremen, Germany , Bremen (Germany)
  • 4 Charité-Universitätsmedizin Berlin, Berlin, Germany , Berlin (Germany)
Type
Published Article
Journal
Journal of Cardiovascular Magnetic Resonance
Publisher
Springer (Biomed Central Ltd.)
Publication Date
Sep 10, 2020
Volume
22
Issue
1
Identifiers
DOI: 10.1186/s12968-020-00657-5
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe posterior wall of the proximal internal carotid artery (ICA) is the predilection site for the development of stenosis. To optimally prevent stroke, identification of new risk factors for plaque progression is of high interest. Therefore, we studied the impact of carotid geometry and wall shear stress on cardiovascular magnetic resonance (CMR)-depicted wall thickness in the ICA of patients with high cardiovascular disease risk.MethodsOne hundred twenty-one consecutive patients ≥50 years with hypertension, ≥1 additional cardiovascular risk factor and ICA plaque ≥1.5 mm thickness and < 50% stenosis were prospectively included. High-resolution 3D-multi-contrast (time of flight, T1, T2, proton density) and 4D flow CMR were performed for the assessment of morphological (bifurcation angle, ICA/common carotid artery (CCA) diameter ratio, tortuosity, and wall thickness) and hemodynamic parameters (absolute/systolic wall shear stress (WSS), oscillatory shear index (OSI)) in 242 carotid bifurcations.ResultsWe found lower absolute/systolic WSS, higher OSI and increased wall thickness in the posterior compared to the anterior wall of the ICA bulb (p < 0.001), whereas this correlation disappeared in ≥10% stenosis. Higher carotid tortuosity (regression coefficient = 0.764; p < 0.001) and lower ICA/CCA diameter ratio (regression coefficient = − 0.302; p < 0.001) were independent predictors of increased wall thickness even after adjustment for cardiovascular risk factors. This association was not found for bifurcation angle, WSS or OSI in multivariate regression analysis.ConclusionsHigh carotid tortuosity and low ICA diameter were independent predictors for wall thickness of the ICA bulb in this cross-sectional study, whereas this association was not present for WSS or OSI. Thus, consideration of geometric parameters of the carotid bifurcation could be helpful to identify patients at increased risk of carotid plaque generation. However, this association and the potential benefit of WSS measurement need to be further explored in a longitudinal study.

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