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Plaque Length and Vessel Diameter Help Predict Carotid Blood Flow Compromise

Degree of carotid stenosis is still relevant

Carotid plaque length and vessel diameter predict ipsilateral carotid blood flow compromise in carotid revascularization patients, according to a study published recently in Neurosurgery.

Traditionally, the degree of carotid stenosis was used to assess hemodynamic compromise in these patients, but the effect of carotid atherosclerotic plaque and parent vessel diameter had never been studied in the setting of carotid disease. The authors of the current study therefore set out to learn more. They prospectively enrolled surgical candidates with greater than 65 percent unilateral carotid stenosis between 2004 and 2007 at their institution. Quantitative magnetic resonance angiography was used to assess plaque length, internal carotid artery vessel diameter, and degree of stenosis. Of 38 eligible patients, 23 had full flow data available for analysis. Eleven patients had 65 to 79 percent stenosis, seven had 80 to 89 percent stenosis, five had 90 percent or greater stenosis, and 60 percent were symptomatic.

Longer carotid artery plaque length and greater native vessel diameter were associated with poorer blood flow, the authors found. They noted that no additional tests were required in the obtaining of these data. Degree of stenosis is still an important part of the equation, but the two new variables are also significant. “Future studies using single intracranial vessel or regional vessel (i.e., middle cerebral artery and anterior cerebral artery) flow measurements will help determine which patients with carotid stenosis have ipsilateral hemispheric flow compromise and whether these pathological hemodynamic states are reversible after carotid revascularization,” they conclude.

Source: Douglas AF, Christopher S, Amankulor N, et al. Extracranial carotid plaque length and parent vessel diameter significantly affect baseline ipsilateral intracranial blood flow. Neurosurgery 69:767-773.