Department of Neurology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Department of Radiology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.
Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
Atherosclerosis. 2022 Jul;352:27-34. doi: 10.1016/j.atherosclerosis.2022.05.016. Epub 2022 May 25.
Evidence shows that artery geometries play a role in atherogenesis by influencing blood flow dynamics. However, whether upstream artery geometries influence downstream atherosclerosis remains unclear. We aimed to investigate whether carotid artery geometries were associated with middle cerebral artery (MCA) atherosclerosis.
We reviewed our institutional database of 3-dimensional head-neck combined high-resolution magnetic resonance imaging. The carotid artery geometries, carotid atherosclerosis, MCA configurations, and MCA atherosclerosis were examined. The associations between carotid artery geometry and MCA atherosclerosis were also analyzed. A final model integrating carotid artery geometries was established, and the incremental diagnostic value was evaluated and compared to a basic model that included only traditional risk factors.
Among the 575 artery units of the ipsilateral carotid artery and MCA, the artery units with MCA plaques (n = 273) were associated with a larger bifurcation angle (odds ratio [OR], 1.138 per 10-degree increase; 95% confidential interval [CI], 1.023-1.264) and kinking-type extracranial internal carotid artery (ICA; OR, 2.193; 95%CI, 1.283-3.748) compared with those without MCA plaques (n = 302). These associations were independent of traditional risk factors, carotid atherosclerosis, and MCA configuration. A larger carotid bifurcation angle was also associated with tandem ICA and MCA atherosclerosis (OR, 1.211 per 10-degree increase; 95%CI, 1.110-1.321). The incremental diagnostic value of carotid artery geometry to traditional risk factors was revealed by comparing the area under the curves of the two diagnostic models (basic model, 0.673 vs. final model, 0.701; p = 0.016).
Carotid artery geometries are independently associated with ipsilateral MCA atherosclerosis, providing new insights into the pathophysiology of intracranial atherosclerosis.
有证据表明，动脉几何形状通过影响血流动力学在动脉粥样硬化形成中起作用。然而，上游动脉几何形状是否影响下游动脉粥样硬化尚不清楚。我们旨在研究颈内动脉几何形状与大脑中动脉（MCA）动脉粥样硬化之间的关系。
我们回顾了我们机构的 3 维头颈部联合高分辨率磁共振成像数据库。检查了颈内动脉几何形状、颈动脉粥样硬化、MCA 结构和 MCA 粥样硬化。还分析了颈动脉几何形状与 MCA 粥样硬化之间的关系。建立了一个整合颈动脉几何形状的最终模型，并评估和比较了该模型与仅包含传统危险因素的基本模型的增量诊断价值。
在同侧颈内动脉和 MCA 的 575 个动脉单位中，有 MCA 斑块的动脉单位（n=273）与更大的分叉角（优势比[OR]，每增加 10°增加 1.138；95%置信区间[CI]，1.023-1.264）和颈内动脉（ICA）的扭转型颅外段（OR，2.193；95%CI，1.283-3.748）相关，而没有 MCA 斑块的动脉单位（n=302）则没有。这些关联独立于传统危险因素、颈动脉粥样硬化和 MCA 结构。更大的颈动脉分叉角也与串联 ICA 和 MCA 粥样硬化相关（OR，每增加 10°增加 1.211；95%CI，1.110-1.321）。通过比较两个诊断模型的曲线下面积，揭示了颈动脉几何形状对传统危险因素的增量诊断价值（基本模型为 0.673，最终模型为 0.701；p=0.016）。
颈内动脉几何形状与同侧 MCA 粥样硬化独立相关，为颅内动脉粥样硬化的病理生理学提供了新的见解。
