title: The impact of expansive arterial remodeling on clinical presentation in carotid artery disease: a multidetector CT angiography study.
abstract: OBJECTIVE
  Atherosclerotic arterial remodeling has been described in the coronary circulation but has not been studied extensively for carotid atherosclerosis. The purpose of our study was to examine the association between carotid artery remodeling and clinical presentation in patients with significant stenosis by using multidetector row CT (MDCT).
  
  
  METHODS
  One hundred eight patients with >or=50% stenosis (North American Symptomatic Carotid Endarterectomy Trial criteria) by MDCT angiography between January 2004 and June 2006 were identified. The study group included 37 symptomatic (65.9 +/- 13.0 years; 12 women; stenosis, 81.5 +/- 12.2%; 17 with stroke; 15 with transient ischemic attack; 5 with amaurosis fugax) and 71 asymptomatic patients (70.5 +/- 10.5 years; 28 women; stenosis, 78.8 +/- 11.1%). Remodeling ratio (RR) was calculated by dividing the outer vessel circumference at the site of greatest stenosis by a normal reference-segment vessel circumference. Maximum vessel thickness (MxVT) and eccentricity index (EI) of the plaque, defined as maximal thickness/minimal thickness at the site of greatest luminal narrowing, were also determined. Data were analyzed by using an independent t test.
  
  
  RESULTS
  The RR was significantly higher in symptomatic patients (1.64 +/- 0.44) than in asymptomatic patients (1.41 +/- 0.5) (P=.02). There was no significant difference in MxVT in symptomatic (5.9 +/- 2.1 mm) and asymptomatic patients (5.6 +/- 2.4 mm) (P=.45) and no significant difference in EI (symptomatic, 4.7 +/- 2.7; asymptomatic, 4.3 +/- 2.2; P=.38).
  
  
  CONCLUSIONS
  In this series of subjects with significant internal carotid artery stenosis, expansive carotid remodeling was significantly greater in patients with cerebral ischemic symptoms than in asymptomatic patients. The extent of expansive remodeling may indicate underlying atherosclerotic plaque vulnerability. MDCT has a role in the evaluation of carotid artery disease beyond examining luminal stenosis.
authors.affiliation: Department of Radiology, University of Virginia Health System, Charlottesville, VA 22908, USA. ah5gy@virginia.edu
authors.forename: A D
authors.initials: AD
authors.lastname: Hardie
authors.forename: C M
authors.initials: CM
authors.lastname: Kramer
authors.forename: P
authors.initials: P
authors.lastname: Raghavan
authors.forename: E
authors.initials: E
authors.lastname: Baskurt
authors.forename: K R
authors.initials: KR
authors.lastname: Nandalur
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011856:Radiographic Image Enhancement / Q000295:instrumentation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods*