Relationship between Vascular Tortuosity Rate and Atherosclerotic Risk Factors in Patients with Carotid Artery...

There is a significant association between carotid artery (CA) stenosis and atherosclerosis, with those patients often presenting with carotid tortuosity. However, the relationship between atherosclerotic risk factors and carotid tortuosity remains controversial. Previous assessments of tortuosity have predominantly utilized qualitative 2D methods. This retrospective study aimed to quantitatively evaluate the tortuosity of CAs in 3D geometry and to investigate the relationship with atherosclerotic risk factors.

A total of 168 CAs in 96 patients diagnosed with at least either-side CA stenosis on magnetic resonance angiography (MRA) between 2011 and 2019 were included in this single-center study, following the exclusion of post-treatment CAs and those with poor imaging quality. The 3D geometries of CAs were segmented using MRA and the centerlines were generated. Vascular tortuosity rate (VTR) was calculated as the curved distance divided by the linear distance between the specified 2 points. The relationship between VTRs and 8 atherosclerotic risk factors-age, body mass index, systolic blood pressure, hemoglobin A1c, high-density lipoprotein, total cholesterol (TC), non-fasting serum triglyceride (TG), and Brinkman index-was analyzed.

Higher VTRs were associated with ≥65 years of age, body mass index ≥25 [kg/m²], serum TC ≥220 [mg/dL], and non-fasting serum TG ≥175 [mg/dL] in common CAs, and body mass index ≥25 [kg/m²], and systolic blood pressure ≥140 [mmHg] in internal CAs.

Quantitative assessment of carotid tortuosity revealed significant associations with several atherosclerotic risk factors, including obesity, hypertension, advanced age, and dyslipidemia, suggesting that VTRs may reflect the presence of these risk factors.