Association between Ischemic Stroke and Vascular Shear Stress in the Carotid Artery
Seul-Ki Jeong1, Jun-Young Lee1, Robert S Rosenson2
1Department of Neurology and Research Institute of Clinical Medicine, Chonbuk National University-Biomedical Institute of Chonbuk National University Hospital, Jeonju, Korea.
Insights
Vascular shear stress in the internal carotid artery (ICA) is lower in ischemic stroke patients. Lower ICA shear stress is linked to increased stroke risk, particularly in recurrent cases.
Area of Science:
- Cardiovascular Science
- Neurology
- Biomedical Engineering
Background:
- Vascular shear stress is crucial for endothelial cell health and function.
- Altered hemodynamics may contribute to ischemic stroke pathogenesis.
- Internal carotid artery (ICA) shear stress differences between stroke patients and controls are not well-established.
Purpose of the Study:
- To investigate and compare internal carotid artery (ICA) shear stress between patients with ischemic stroke and healthy individuals.
- To determine if ICA shear stress is associated with stroke risk or stroke recurrence.
Main Methods:
- ICA shear stress was quantified in 143 controls and 122 ischemic stroke patients (first-ever or recurrent).
- Patients with normal ICA or <50% stenosis were included; cardioembolic strokes were excluded.
- Statistical models adjusted for age, sex, and vascular risk factors.
Main Results:
- Ischemic stroke patients exhibited larger carotid diameters and lower peak-systolic/end-diastolic velocities compared to controls.
- Mean peak-systolic and end-diastolic ICA shear stress were significantly lower in ischemic stroke patients.
- Lowest ICA shear stress was observed in patients with recurrent stroke or small-vessel occlusion; higher shear stress correlated with lower stroke risk.
Conclusions:
- Internal carotid artery (ICA) shear stress is significantly reduced in patients experiencing ischemic stroke.
- Lower ICA shear stress may represent a risk factor or consequence of ischemic stroke.
- Further research is needed to elucidate the causal link between ICA shear stress and ischemic stroke.
Background And Purpose:
Vascular shear stress is essential for maintaining the morphology and function of endothelial cells. We hypothesized that shear stress in the internal carotid artery (ICA) may differ between patients with ischemic stroke and healthy control subjects.
Methods:
ICA shear stress was calculated in 143 controls and 122 patients with ischemic stroke who had a normal ICA or an ICA with <50% stenosis. The stroke group included patients who presented with a first-ever or recurrent ischemic stroke but excluded cardioembolic stroke and uncertain etiologies. Of the 122 patients, 107 (87.7%) and 15 (12.3%) patients were categorized as first-ever and recurrent stroke, respectively.
Results:
Carotid diameters were significantly larger, and both peak-systolic and end-diastolic velocities were significantly lower in patients with ischemic stroke than in controls (all p values <0.05). Mean values of peak-systolic and end-diastolic shear stress in both ICAs were significantly lower in patients with ischemic stroke in models that adjusted for age, sex, and vascular risk factors (p for trend <0.05). The ICA shear stress was lowest in patients with recurrent stroke or the subtype of small-vessel occlusion. Higher peak-systolic and end-diastolic shear stresses in both ICAs were independently and negatively associated with ischemic stroke after adjusting for potential confounders (all p values <0.05).
Conclusions:
ICA shear stresses were significantly lower in patients with ischemic stroke than in control subjects. Future studies should attempt to define the causal relationship between carotid arterial shear stress and ischemic stroke.
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The average shearing stress can be calculated by dividing the shear by the area of the cross-section.