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Middle cerebral artery pressure laterality in patients with symptomatic ICA stenosis.

Authors
  • Holmgren, Madelene1
  • Støverud, Karen-Helene1
  • Zarrinkoob, Laleh2, 3
  • Wåhlin, Anders1, 4
  • Malm, Jan2
  • Eklund, Anders1, 4
  • 1 Department of Radiation Sciences, Umeå University, Umeå, Sweden. , (Sweden)
  • 2 Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden. , (Sweden)
  • 3 Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. , (Sweden)
  • 4 Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden. , (Sweden)
Type
Published Article
Journal
PLoS ONE
Publisher
Public Library of Science
Publication Date
Jan 01, 2021
Volume
16
Issue
1
Identifiers
DOI: 10.1371/journal.pone.0245337
PMID: 33417614
Source
Medline
Language
English
License
Unknown

Abstract

An internal carotid artery (ICA) stenosis can potentially decrease the perfusion pressure to the brain. In this study, computational fluid dynamics (CFD) was used to study if there was a hemispheric pressure laterality between the contra- and ipsilateral middle cerebral artery (MCA) in patients with a symptomatic ICA stenosis. We further investigated if this MCA pressure laterality (ΔPMCA) was related to the hemispheric flow laterality (ΔQ) in the anterior circulation, i.e., ICA, proximal MCA and the proximal anterior cerebral artery (ACA). Twenty-eight patients (73±6 years, range 59-80 years, 21 men) with symptomatic ICA stenosis were included. Flow rates were measured using 4D flow MRI data (PC-VIPR) and vessel geometries were obtained from computed tomography angiography. The ΔPMCA was calculated from CFD, where patient-specific flow rates were applied at all input- and output boundaries. The ΔPMCA between the contra- and ipsilateral side was 6.4±8.3 mmHg (p<0.001) (median 3.9 mmHg, range -1.3 to 31.9 mmHg). There was a linear correlation between the ΔPMCA and ΔQICA (r = 0.85, p<0.001) and ΔQACA (r = 0.71, p<0.001), respectively. The correlation to ΔQMCA was weaker (r = 0.47, p = 0.011). In conclusion, the MCA pressure laterality obtained with CFD, is a promising physiological biomarker that can grade the hemodynamic disturbance in patients with a symptomatic ICA stenosis.

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