GEOMETRY OF TERMINAL INTERNAL CAROTID ARTERY BIFURCATION ASSOCIATED WITH MIDDLE CEREBRAL ARTERY PLAQUE ULCERATION (ID 992)

Presentation Topic
AS20 LARGE ARTERY ATHEROSCLEROSIS - INCLUDING INTRACRANIAL STENOSIS
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Abstract

Background And Aims

Geometry of terminal internal carotid artery (ICA) bifurcation may affect initiation and development of atherosclerotic middle cerebral artery (MCA) plaques. We aimed to investigate the association between ICA bifurcation geometry and MCA plaque ulceration.

Methods

In a prospective, multicenter referral, cross-sectional study, we recruited adult patients with acute ischemic stroke or transient ischemic attack (TIA) attributed to high-grade (60-99%), atherosclerotic M1 MCA stenosis confirmed by 3-dimensional rotational angiography (3DRA). We classified the MCA lesions as smooth, irregular and ulcerative plaques by the surface contour in 3DRA. We assessed the geometric features of terminal ICA bifurcation in 3DRA, including the diameters of the arteries and ratios of the cross-sectional areas, and the angle between MCA and anterior cerebral artery (ACA). We compared baseline characteristics and ICA bifurcation geometry between patients with different plaque types.

Results

Among 142 patients (median age 59 years; 65.5% males) with symptomatic MCA stenosis (median stenosis 77%), 46 (32.4%), 81 (57.0%) and 15 (10.6%) respectively had smooth, irregular and ulcerative plaques. With similar demographics and histories of conventional vascular risk factors (e.g., hypertension, diabetes and dyslipidemia), those with an ulcerative MCA plaque had a smaller MCA/ACA area ratio (medians 1.46 versus 1.72; p=0.036) and a smaller MCA-ACA angle (medians 101.4 versus 113.1 º; p=0.026) than other plaque types.

Conclusions

Geometry of terminal ICA bifurcation, e.g., smaller MCA/ACA area ratio and MCA-ACA angle, may be associated with MCA plaque ulceration. Rheological studies are needed to reveal the possible hemodynamic mechanisms.

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Not applicable

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