Advanced

AJNR - American Journal of Neuroradiology

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hardie, A.D. Articles by Nandalur, K.R. Search for Related Content PubMed Articles by Hardie, A.D. Articles by Nandalur, K.R.

American Journal of Neuroradiology 28:1067-1070, June-July 2007
DOI 10.3174/ajnr.A0508
© 2007 American Society of Neuroradiology

BRAIN

The Impact of Expansive Arterial Remodeling on Clinical Presentation in Carotid Artery Disease: A Multidetector CT Angiography Study

A.D. Hardie^a, C.M. Kramer^a,b, P. Raghavan^a, E. Baskurt^a and K.R. Nandalur^c

^a Departments of Radiology, University of Virginia Health System, Charlottesville, Va
^b Medicine, University of Virginia Health System, Charlottesville, Va
^c Department of Radiology, William Beaumont Hospital, Royal Oak, Mich

Please address correspondence to Andrew D. Hardie, MD, Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908; e-mail: ah5gy{at}virginia.edu

BACKGROUND AND PURPOSE: Atherosclerotic arterial remodeling has been described in the coronary circulation but has not been studied extensively for carotid atherosclerosis. The purpose of our study was to examine the association between carotid artery remodeling and clinical presentation in patients with significant stenosis by using multidetector row CT (MDCT).

MATERIALS AND METHODS: One hundred eight patients with 50% stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria) by MDCT angiography between January 2004 and June 2006 were identified. The study group included 37 symptomatic (65.9 ± 13.0 years; 12 women; stenosis, 81.5 ± 12.2%; 17 with stroke; 15 with transient ischemic attack; 5 with amaurosis fugax) and 71 asymptomatic patients (70.5 ± 10.5 years; 28 women; stenosis, 78.8 ± 11.1%). Remodeling ratio (RR) was calculated by dividing the outer vessel circumference at the site of greatest stenosis by a normal reference-segment vessel circumference. Maximum vessel thickness (MxVT) and eccentricity index (EI) of the plaque, defined as maximal thickness/minimal thickness at the site of greatest luminal narrowing, were also determined. Data were analyzed by using an independent t test.

RESULTS: The RR was significantly higher in symptomatic patients (1.64 ± 0.44) than in asymptomatic patients (1.41 ± 0.5) (P=.02). There was no significant difference in MxVT in symptomatic (5.9 ± 2.1 mm) and asymptomatic patients (5.6 ± 2.4 mm) (P=.45) and no significant difference in EI (symptomatic, 4.7 ± 2.7; asymptomatic, 4.3 ± 2.2; P=.38).

CONCLUSION: In this series of subjects with significant internal carotid artery stenosis, expansive carotid remodeling was significantly greater in patients with cerebral ischemic symptoms than in asymptomatic patients. The extent of expansive remodeling may indicate underlying atherosclerotic plaque vulnerability. MDCT has a role in the evaluation of carotid artery disease beyond examining luminal stenosis.

This article has been cited by other articles:

				M. Tsutsumi, H. Aikawa, M. Onizuka, M. Iko, T. Kodama, K. Nii, S. Hamaguchi, H. Etou, K. Sakamoto, and K. Kazekawa Carotid Artery Stenting for Calcified Lesions AJNR Am. J. Neuroradiol., September 1, 2008; 29(8): 1590 - 1593. [Abstract] [Full Text] [PDF]

				T. Ohara, K. Toyoda, R. Otsubo, K. Nagatsuka, Y. Kubota, M. Yasaka, H. Naritomi, and K. Minematsu Eccentric Stenosis of the Carotid Artery Associated with Ipsilateral Cerebrovascular Events AJNR Am. J. Neuroradiol., June 1, 2008; 29(6): 1200 - 1203. [Abstract] [Full Text] [PDF]