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Atherosclerotic plaque locations may be related to different ischemic lesion patterns
Ho Geol Woo1, Sung Hyuk Heo1, Eui Jong Kim2
1Departments of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea.
Insights
Internal carotid artery (ICA) plaque location and geometry influence stroke lesion patterns. Low-body plaques correlate with small lesions, while high-apical plaques link to larger, multiple lesions.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Internal carotid artery (ICA) atherosclerosis is a significant cause of ischemic stroke, primarily due to artery-to-artery embolism.
- Understanding the relationship between atherosclerotic plaque characteristics and stroke lesion patterns is crucial for risk stratification and treatment.
Purpose of the Study:
- To investigate the association between internal carotid artery (ICA) geometry, plaque location, and ischemic stroke lesion patterns.
- To determine if specific ICA atherosclerotic plaque features predict the type and size of cerebral lesions.
Main Methods:
- Enrolled ischemic stroke patients with symptomatic >50% proximal ICA stenosis.
- Classified carotid plaque location as high-apical or low-body and measured ICA geometric parameters (arterial angles).
- Analyzed ischemic lesion patterns based on number, location, and size; investigated associations with plaque characteristics.
Main Results:
- Low-body plaques (n=62) were associated with wider common carotid artery (CCA)-ICA angles and more small, scattered lesions compared to high-apical plaques (n=31).
- High-apical plaques were more frequently linked to large lesions with additional lesions.
- Low-body plaque presence was independently associated with a small lesion-only pattern (OR: 3.106).
Conclusions:
- Carotid plaque location (low-body vs. high-apical) is significantly associated with distinct ischemic stroke lesion patterns.
- Low-body plaques correlate with smaller, scattered lesions, whereas high-apical plaques are linked to larger, more complex lesions.
- A wider CCA-ICA angle is associated with low-body plaque, suggesting a role for vascular geometry in stroke etiology.
Background:
Atherosclerosis of the internal carotid artery (ICA) is an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. This study hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with lesion pattern in patients with acute ischemic stroke.
Methods:
Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured, and ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern, dichotomized by size, were investigated.
Results:
Of the 93 acute ischemic stroke patients enrolled, 31 had high-apical and 62 had low-body plaques. Hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (167.7 ± 10.4° vs 162.3 ± 9.8°, p = 0.019) in patients with low-body than high-apical plaques. Low-body plaques were more frequently associated with small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques were more frequently associated with large lesions having additional lesions (38.7% vs. 11.3%, p = 0.002). The presence of low-body plaques (odds ratio: 3.106, 95% confidence interval: 1.105-8.728, p = 0.032) was independently associated with the small lesion-only pattern.
Conclusions:
Low-body plaques are more frequently associated with small scattered lesions, whereas high-apical plaques are more frequently associated with large lesions having additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.
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