Morphometric and hemodynamic analysis of atherosclerotic progression in human carotid artery bifurcations
Xu Huang1, Xiaoping Yin2, Yingjin Xu2
1Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China; State Key Laboratory for Turbulence and Complex Systems, College of Engineering, Peking University, Beijing, China;
Insights
Atherosclerosis in carotid artery disease patients shows distinct geometric and hemodynamic differences compared to healthy individuals. These changes, particularly larger angles and smaller external carotid artery diameters, indicate plaque initiation in the internal carotid artery.
Area of Science:
- Vascular biology and imaging
- Biomedical engineering
- Cardiovascular research
Background:
- Carotid artery bifurcation atherosclerosis is common, but detailed morphometric and hemodynamic data across disease stages are limited.
- Understanding geometric and flow changes is crucial for diagnosing and managing carotid artery disease.
Purpose of the Study:
- To compare morphometric and hemodynamic differences in carotid artery bifurcations between patients with carotid artery disease and healthy controls.
- To identify specific geometric features associated with atherosclerosis progression.
Main Methods:
- Three-dimensional (3D) reconstruction of carotid artery bifurcations using computed tomography angiography (CTA) in 30 patients and 30 controls.
- Definition of novel vector angles and computation of best-fit diameters along the internal carotid artery (ICA) centerline.
- Hemodynamic analysis performed at various bifurcation points.
Main Results:
- Patients with carotid artery disease exhibited significantly larger vector angles (1 and 2) and smaller external carotid artery (ECA) diameters compared to controls.
- No significant difference in common carotid artery (CCA) diameter was observed between groups.
- Stenosis was consistently found in the proximal ICA (sinus and carina regions) in all patients, with further progression in 20-40% of cases.
Conclusions:
- Morphometric and hemodynamic analyses reveal distinct geometric alterations in carotid artery bifurcations affected by atherosclerosis.
- Atherosclerotic plaques appear to initiate in the sinus and carina regions of the ICA and progress distally.
- These findings provide valuable insights into the early stages and progression patterns of carotid artery disease.
Abstract:
Although atherosclerosis has been widely investigated at carotid artery bifurcation, there is a lack of morphometric and hemodynamic data at different stages of the disease. The purpose of this study was to determine the lesion difference in patients with carotid artery disease compared with healthy control subjects. The three-dimensional (3D) geometry of carotid artery bifurcation was reconstructed from computed tomography angiography (CTA) images of Chinese control subjects (n = 30) and patients with carotid artery disease (n = 30). We defined two novel vector angles (i.e., angles 1 and 2) that were tangential to the reconstructed contour of the 3D vessel. The best-fit diameter was computed along the internal carotid artery (ICA) center line. Hemodynamic analysis was performed at various bifurcations. Patients with stenotic vessels have larger angles 1 and 2 (151 ± 11° and 42 ± 20°) and smaller diameters of the external carotid artery (ECA) (4.6 ± 0.85 mm) compared with control subjects (144 ± 13° and 36 ± 16°, 5.2 ± 0.57 mm) although there is no significant difference in the common carotid artery (CCA) (7.1 ± 1.2 vs. 7.5 ± 1.0 mm, P = 0.18). In particular, all patients with carotid artery disease have a stenosis at the proximal ICA (including both sinus and carina regions), while 20% of patients have stenosis at the middle ICA and 20% have stenosis expansion to the entire cervical ICA. Morphometric and hemodynamic analyses suggest that atherosclerotic plaques initiate at both sinus and carina regions of ICA and progress downstream.
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