Payam B Bijari1, Bruce A Wasserman, David A Steinman. 1. From the Biomedical Simulation Laboratory, Department of Mechanical and Industrial Engineering and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (P.B.B., D.A.S.); and Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (B.A.W.).
Abstract
BACKGROUND AND PURPOSE: Lumen geometry has long been suspected as a risk factor for atherosclerosis by virtue of its influence on blood flow disturbances. Confirmation of this geometric risk hypothesis has, however, proved challenging owing to possible effects of wall thickening on geometry and unproven links between candidate geometric variables and disturbed flow. The purpose of this study was to overcome these challenges. METHODS: The study relied on imaging and risk factor data from progressively refined subsets of the Atherosclerosis Risk in Communities (ARIC) Carotid MRI study. Group 1 (n=467) included only nonstenotic cases having sufficient quality angiography for 3-dimensional analysis. Group 2 (n=346) excluded cases from group 1 having common and internal carotid artery wall thickness above previously identified thresholds for inward remodeling. Group 3 (n=294) excluded cases from group 2 having lumen irregularities and thus was least likely to include lumen geometries influenced by wall thickening. RESULTS: Multiple linear regressions showed that for group 3, bifurcation flare and proximal curvature were independent predictors of internal carotid artery wall thickness, consistent with their previously demonstrated roles in predicting disturbed flow. For the broadest group 1, flare was an independent predictor of internal carotid artery wall thickness but with a sign change in regression coefficient reflecting effects of wall thickening on lumen geometry. CONCLUSIONS: Carotid bifurcation geometry is an independent, albeit weak, predictor of its early wall thickening, but only when assumptions about geometric factors, and the influence of disease on them, are confronted. This highlights pitfalls of previous attempts to confirm geometric risk of atherosclerosis.
BACKGROUND AND PURPOSE: Lumen geometry has long been suspected as a risk factor for atherosclerosis by virtue of its influence on blood flow disturbances. Confirmation of this geometric risk hypothesis has, however, proved challenging owing to possible effects of wall thickening on geometry and unproven links between candidate geometric variables and disturbed flow. The purpose of this study was to overcome these challenges. METHODS: The study relied on imaging and risk factor data from progressively refined subsets of the Atherosclerosis Risk in Communities (ARIC) Carotid MRI study. Group 1 (n=467) included only nonstenotic cases having sufficient quality angiography for 3-dimensional analysis. Group 2 (n=346) excluded cases from group 1 having common and internal carotid artery wall thickness above previously identified thresholds for inward remodeling. Group 3 (n=294) excluded cases from group 2 having lumen irregularities and thus was least likely to include lumen geometries influenced by wall thickening. RESULTS: Multiple linear regressions showed that for group 3, bifurcation flare and proximal curvature were independent predictors of internal carotid artery wall thickness, consistent with their previously demonstrated roles in predicting disturbed flow. For the broadest group 1, flare was an independent predictor of internal carotid artery wall thickness but with a sign change in regression coefficient reflecting effects of wall thickening on lumen geometry. CONCLUSIONS: Carotid bifurcation geometry is an independent, albeit weak, predictor of its early wall thickening, but only when assumptions about geometric factors, and the influence of disease on them, are confronted. This highlights pitfalls of previous attempts to confirm geometric risk of atherosclerosis.
Entities:
Keywords:
atherosclerosis; carotid arteries; hemodynamics; magnetic resonance imaging; risk factors
Authors: Jonathan B Thomas; Lisa Jong; J David Spence; Bruce A Wasserman; Brian K Rutt; David A Steinman Journal: J Magn Reson Imaging Date: 2005-06 Impact factor: 4.813
Authors: Matthias Sitzer; Damir Puac; Alexandra Buehler; Donata A Steckel; Stephan von Kegler; Hugh S Markus; Helmuth Steinmetz Journal: Stroke Date: 2003-03-13 Impact factor: 7.914
Authors: Sekou Gregg; Terry Y Li; Marie-France Hétu; Stephen C Pang; Paul Ewart; Amer M Johri Journal: Int J Cardiovasc Imaging Date: 2018-02-20 Impact factor: 2.357
Authors: Caitlin W Hicks; Natalie R Daya; James H Black; Kunihiro Matsushita; Elizabeth Selvin Journal: Atherosclerosis Date: 2019-11-01 Impact factor: 5.162
Authors: Victor J Del Brutto; Chuanhui Dong; Kaylie Cullison; Michelle R Caunca; Marialaura Simonetto; Digna E Cabral; Jose Gutierrez; Mitchell S V Elkind; Ralph L Sacco; Tatjana Rundek Journal: J Stroke Cerebrovasc Dis Date: 2022-05-26 Impact factor: 2.677
Authors: Diego Gallo; Payam B Bijari; Umberto Morbiducci; Ye Qiao; Yuanyuan Joyce Xie; Maryam Etesami; Damiaan Habets; Edward G Lakatta; Bruce A Wasserman; David A Steinman Journal: J R Soc Interface Date: 2018-10-10 Impact factor: 4.118
Authors: Navneet Singh; Alan R Moody; Idan Roifman; David A Bluemke; Anna E H Zavodni Journal: Int J Cardiovasc Imaging Date: 2015-08-21 Impact factor: 2.357