Pathological-anatomical study concerning the geometry and atherosclerosis of the carotid bifurcation
A G Spelde1, R A de Vos, I J Hoogendam
1Department of Surgery, Hospital Ziekenzorg Enschede, The Netherlands.
Insights
Non-optimal carotid bifurcation geometry, indicated by a low area ratio, is linked to atherosclerosis development. This suggests geometric factors play a role in the hardening of arteries.
Area of Science:
- Cardiovascular science
- Biomedical engineering
- Medical research
Background:
- Hemodynamic factors, alongside metabolic influences, are critical in the progression of obliterating atherosclerosis.
- The geometric configuration of arterial bifurcations significantly impacts local blood flow dynamics.
- Altered blood flow patterns resulting from non-optimal geometry may contribute to atherogenesis.
Purpose of the Study:
- To investigate the correlation between non-optimal carotid bifurcation geometry and the presence of atherosclerotic lesions.
- To test the hypothesis that specific bifurcation geometries promote flow disturbances contributing to atherosclerosis.
Main Methods:
- Post-mortem examination of 100 carotid bifurcations.
- Calculation of the area ratio (sum of distal artery cross-sectional areas divided by proximal artery cross-sectional area) as a measure of bifurcation geometry.
- Comparison of area ratios in normal versus diseased carotid bifurcations.
Main Results:
- The mean area ratio for 60 normal carotid bifurcations was 1.47.
- The mean area ratio for 40 diseased carotid bifurcations was 0.99.
- The area ratio in diseased bifurcations (0.99) was significantly lower than the theoretical optimal ratio of 1.16, associated with minimal energy loss and pressure wave reflection.
Conclusions:
- A non-optimal area ratio in carotid bifurcations appears to be a contributing factor in the development of atherosclerosis.
- Carotid artery geometry influences hemodynamic conditions that may promote atherosclerotic plaque formation.
Abstract:
Besides metabolic factors haemodynamic elements are important in the development of obliterating athero-sclerosis. Since the geometry of a bifurcation influences the local bloodflow, we hypothesise that non-optimal geometry of a bifurcation leads to flow-disturbances, which can be a factor in atherogenesis. To verify our hypothesis that there is a correlation between non-optimal geometry of a bifurcation and the presence of atherosclerotic lesions, we studied as a parameter for the geometry of a bifurcation the area ratio defined as: the sum of the cross-sectional areas of the distal arteries divided by the cross-sectional area of the proximal artery. In this study the area ratios of 100 carotid bifurcations were studied by post-mortem examination. The mean value calculated for 60 normal carotid bifurcations was 1.47, and the mean for 40 diseased bifurcations was 0.99. The last value is significantly less than the theoretical optimal area ratio of 1.16, which was found by Womersley and Hunt as the value at which a minimum reflexion of pressure waves and a minimum of blood-flow energy loss occurs at a bifurcation. We conclude that a non-optimal area ratio of a carotid bifurcation seems to be a factor in atherogenesis.
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