title: Intramural location and size of arterial calcification are associated with stenosis at carotid bifurcation.
abstract: OBJECTIVE
  The purpose of this study was to investigate the association between internal carotid artery (ICA) stenosis and intramural location and size of calcification at the ICA origins and the origins of the cervical arteries proximal to the ICA.
  
  
  METHODS
  A total of 1139 ICAs were evaluated stenosis and calcification on the multi-detector row CT angiography. The intramural location was categorized into none, outside and inside location. The calcification size was evaluated on the 4-point grading scale. The multivariate analyses were adjusted for age, serum creatinine level, hypertension, hyperlipidemia, diabetes mellitus, smoking and alcohol habits.
  
  
  RESULTS
  Outside calcification at the ICA origins showed the highest multivariate odds ratio (OR) for the presence of ICA stenosis (30.0) and severe calcification (a semicircle or more of calcification at the arterial cross-sectional surfaces) did the second (14.3). In the subgroups of >70% ICA stenosis, the multivariate OR of outside location increased to 44.8 and that of severe calcification also increased to 32.7. Four of 5 calcified carotid plaque specimens extracted by carotid endarterectomy were histologically confirmed to be calcified burdens located outside the internal elastic lamia which were defined as arterial medial calcification.
  
  
  CONCLUSIONS
  ICA stenosis was strongly associated with severe calcification located mainly outside the carotid plaque. Outside calcification at the ICA origins should be evaluated separately from inside calcification, as a marker for the ICA stenosis. Additionally, we found that calcification at the origins of the cervical arteries proximal to the ICA was significantly associated with the ICA stenosis.
authors.affiliation: Department of Neurosurgery & Stroke Center, Rakuwakai Otowa Hospital, Otowachinji-cho 2, Yamashina-ku, Kyoto 607-8602, Japan; Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan; Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan. Electronic address: shigekiyamada3@gmail.com.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yamada
authors.affiliation: Interfaculty Initiative in Information Studies/Institute of Industrial Science, The University of Tokyo, 4-6-1 Komaba, Meguro-ku, Tokyo 153-8505, Japan. Electronic address: marie@iis.u-tokyo.ac.jp.
authors.forename: Marie
authors.initials: M
authors.lastname: Oshima
authors.affiliation: Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan. Electronic address: ynabe@magic.odn.ne.jp.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan. Electronic address: hidogata@gmail.com.
authors.forename: Hideki
authors.initials: H
authors.lastname: Ogata
authors.affiliation: Department of Neurosurgery, Kishiwada Municipal Hospital, 1001 Gakuhara-cho, Kishiwada city, Osaka 596-8501, Japan. Electronic address: hashiken8022@yahoo.co.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hashimoto
authors.affiliation: Department of Neurosurgery, Hamamatsu Rosai Hospital, 25 Shogen-cho, Higashi-ku, Hamamatsu city, Shizuoka 430-8525, Japan. Electronic address: hi-miyake@hamamatsuh.rofuku.go.jp.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Miyake
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D061205:Vascular Calcification / Q000000981:diagnostic imaging*
keywords: Arterial calcification; Arteriosclerosis; Carotid bifurcation; Multi-detector row CT; Stenosis