Carotid geometry is independently associated with complicated carotid artery plaques

Christoph Strecker; Anna Kopczak; Tobias Saam; Dominik Sepp; Anja Hennemuth; Ernst Mayerhofer; Sven Poli; Ulf Ziemann; Holger Poppert; Andreas Schindler; Andreas Harloff

doi:10.3389/fcvm.2023.1177998

Carotid geometry is independently associated with complicated carotid artery plaques

Front Cardiovasc Med. 2023 Jun 12:10:1177998. doi: 10.3389/fcvm.2023.1177998. eCollection 2023.

Authors

Affiliations

¹ Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
² Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany.
³ Die Radiologie, Rosenheim, Germany.
⁴ Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Munich, Germany.
⁵ Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.
⁶ Department of Neurology, Massachusetts General Hospital, Boston, MA, United States.
⁷ Department of Neurology and Stroke and Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
⁸ Department of Neurology, Helios Klinikum München West, Munich, Germany.
⁹ Institute of Neuroradiology, University Hospital, LMU Munich, Munich, Germany.

^# Contributed equally.

Abstract

Introduction: Complicated carotid artery plaques (cCAPs) are associated with an increased risk of rupture and subsequent stroke. The geometry of the carotid bifurcation determines the distribution of local hemodynamics and could thus contribute to the development and composition of these plaques. Therefore, we studied the role of carotid bifurcation geometry in the presence of cCAPs.

Methods: We investigated the association of individual vessel geometry with carotid artery plaque types in the Carotid Plaque Imaging in Acute Stroke (CAPIAS) study. After excluding arteries without plaque or with insufficient MRI quality, 354 carotid arteries from 182 patients were analyzed. Individual parameters of carotid geometry [i.e., internal carotid artery (ICA)/common carotid artery (CCA) ratio, bifurcation angle, and tortuosity) were derived from time-of-flight MR images. The lesion types of carotid artery plaques were determined according to the American Heart Association classification of lesions by multi-contrast 3T-MRI. The association between carotid geometry and a cCAP was studied using logistic regression after adjusting for age, sex, wall area, and cardiovascular risk factors.

Results: Low ICA/CCA ratios (OR per SD increase 0.60 [95%CI: 0.42-0.85]; p = 0.004) and low bifurcation angles (OR 0.61 [95%CI: 0.42-0.90]; p = 0.012) were significantly associated with the presence of cCAPs after adjusting for age, sex, cardiovascular risk factors, and wall area. Tortuosity had no significant association with cCAPs. Only ICA/CCA ratio remained significant in a model containing all three geometric parameters (OR per SD increase 0.65 [95%CI: 0.45-0.94]; p = 0.023).

Conclusions: A steep tapering of the ICA relative to the CCA and, to a lesser extent, a low angle of the carotid bifurcation were associated with the presence of cCAPs. Our findings highlight the contribution of bifurcation geometry to plaque vulnerability. Thus, assessment of carotid geometry could be helpful in identifying patients at risk of cCAPs.

Keywords: atherosclerosis; carotid artery; carotid geometry; complicated plaque; magnetic resonance imaging; multicontrast plaque imaging.

Grants and funding

This work was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) under Germany's Excellence Strategy within the framework of Munich Cluster for Systems Neurology (EXC 2145 SyNergy, ID 390857198). Andreas Harloff was funded by the Berta-Ottenstein-Programme for Advanced Clinician Scientists, Medical Faculty, University of Freiburg and DFG grant HA5399/5-1. Christoph Strecker was funded by DFG grant HA5399/5-1. The article processing charge was funded by the Baden-Wuerttemberg Ministry of Science, Research and Art and the Albert Ludwigs University Freiburg under the Open Access Publishing funding programme.