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Neurosurgery. 2011 Oct;69(4):767-73; discussion 773. doi: 10.1227/NEU.0b013e31821ff8f4.

Extracranial carotid plaque length and parent vessel diameter significantly affect baseline ipsilateral intracranial blood flow.

Author information

1
Wallace Trials Center, Greenwich Hospital, Greenwich, CT, USA. afdouglasmd@aol.com

Abstract

BACKGROUND:

The degree of carotid artery stenosis has traditionally been used as a marker of hemodynamic compromise and increased stroke risk. However, the hemodynamic effect of carotid atherosclerotic plaque length on cerebral blood flow has not previously been studied.

OBJECTIVE:

To determine whether carotid plaque length, in addition to degree of stenosis, significantly affects carotid blood flow in patients with >65% carotid stenosis.

METHODS:

Consecutively treated surgical patients with unilateral >65% carotid stenosis at a single institution were analyzed. Quantitative measurements of plaque length, internal carotid artery (ICA) vessel diameter, and degree of stenosis were made from magnetic resonance angiography images. Quantitative phase-contrast magnetic resonance angiography flow maps were generated to estimate ICA flow compromise by calculating a ratio of the ipsilateral/contralateral ICA flow rates.

RESULTS:

Of 38 eligible patients, 23 had full anatomic and ICA flow data sets available for analysis. Univariate regression analysis demonstrated that longer carotid plaques and increasing percentage carotid stenosis were associated with a significant decline in ipsilateral ICA flow (P = .008 and P = .02, respectively). A multivariate regression identified both plaque length and vessel diameter as independent predictors of ICA flow (P = .001 and P = .002, respectively).

CONCLUSION:

Carotid plaque length and vessel diameter appear to be significant variables, in addition to degree of stenosis, in predicting ipsilateral carotid blood flow compromise in patients undergoing carotid revascularization.

PMID:
21508878
DOI:
10.1227/NEU.0b013e31821ff8f4
[Indexed for MEDLINE]

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