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Atherosclerosis in the human common carotid artery. A morphometric study of 31 specimens
L Goubergrits1, K Affeld, J Fernandez-Britto
1Biofluidmechanics Laboratory, Universitätsklinikum Charité, Humboldt University of Berlin, Germany. leonid.goubergrits@charite.de
Insights
Atherosclerotic plaques predominantly affect the internal and external carotid branches. Carotid sinus enlargement is a key geometric risk factor for atherosclerosis, while branch angles are not correlated.
Area of Science:
- Vascular pathology and fluid mechanics
- Biomedical engineering
- Medical imaging and analysis
Background:
- The carotid artery bifurcation is prone to atherosclerosis and complex hemodynamics.
- Existing knowledge lacks detailed correlation between plaque location, severity, and carotid bifurcation geometry.
- Understanding these factors is crucial for predicting atherosclerotic disease development.
Purpose of the Study:
- To quantify geometrical risk factors associated with atherosclerotic plaque deposition in the carotid artery bifurcation.
- To investigate the correlation between specific geometric parameters and the level/position of atherosclerotic lesions.
- To fill the knowledge gap regarding the quantitative relationship between carotid bifurcation anatomy and atherosclerosis.
Main Methods:
- Excised carotid arteries from 23 autopsied individuals were used.
- Vessel casts were created by filling arteries with resin under transmural pressure.
- Geometrical parameters were measured from casts, and pathomorphological analysis identified atherosclerotic lesions using an atherometric system (AS).
Main Results:
- Advanced atherosclerotic lesions (fibrous and severe plaques) constituted ~70% of all lesions, primarily in the internal and external carotid branches.
- Only ~25% of lesions were found in the common carotid branch.
- Carotid sinus enlargement (>1.2 times the common carotid branch diameter) was identified as a significant geometric risk factor; no correlation was found with branch angles.
Conclusions:
- Quantification of geometric risk factors is vital for understanding atherosclerotic disease progression.
- Carotid sinus enlargement is a key anatomical predictor of atherosclerosis severity at the bifurcation.
- Targeted interventions may benefit from considering specific geometric features of the carotid bifurcation.
Abstract:
The carotid artery bifurcation is of special interest to both the pathologist because of its frequent atherosclerotic depositions, and to the fluidmechanicist because of its complex flow properties. However, current knowledge is incomplete regarding the level and position of atherosclerotic plaques in the carotid bifurcation and their quantitative correlation with its geometry. The study presented here is intended to fill that knowledge gap and try to quantify the geometrical risk factors. During the post-mortem the arteries were excised and filled with a resin at the proper transmural pressure of 80 mm Hg. Thirty-one vessel casts of the carotid artery from twenty-three autopsied individuals were made. The vessel casts were used to measure several geometrical parameters. After fabrication of the vessel casts each artery was investigated according to pathomorphological procedure. An atherometric system (AS) indicating the level of atherosclerotic lesions was applied. The specimens were divided into three groups according to the level of atherosclerosis. The comparison was made between the level of wall alteration of the main branches of the carotid bifurcation (common, internal and external carotid branch), and between these three groups themselves. Further, we conducted a comparison of the averaged geometric parameters in different groups to define the correlations between atherosclerotic lesions and geometric parameters. The results show that the most advanced lesions (fibrous and severe plaques) with about 70% of all lesions were mainly found in the internal and the external carotid branches, compared with only 25% for the common carotid branch. The comparative analysis showed that a relatively high carotid sinus enlargement of > 1.2 of the common carotid branch diameter is a most significant geometric risk factor among those investigated, whereas there was no correlation between branch angles and atherosclerosis. In conclusion, the quantification of atherosclerotic risk factors is very important in the investigation of atherosclerotic disease development.