title: The association between expansive arterial remodeling detected by high-resolution MRI in carotid artery stenosis and clinical presentation.
abstract: OBJECTIVE
  The purpose of the present study was to investigate the association between carotid artery (CA) expansive remodeling (ER) and symptoms of cerebral ischemia.
  
  
  METHODS
  One hundred twenty-two consecutive CAs scheduled for CA endarterectomy (CEA) or CA stent placement (CAS) were retrospectively studied. After excluding 22 CAs (2 were contraindicated for MRI, 8 had near-occlusion, 6 had poor image quality, and 6 had restenosis after CEA or CAS), there were 100 CAs (100 patients) included in the final analysis. The study included 50 symptomatic patients (mean age 73.6 ± 8.9 years, 6 women, mean stenosis 68.5% ± 21.3%) and 50 asymptomatic patients (mean age 72.0 ± 5.9 years, 5 women, mean stenosis 79.4% ± 8.85%). Expansive remodeling was defined as enlargement of the internal carotid artery (ICA) with outward plaque growth. The ER ratio was calculated by dividing the maximum distance between the lumen and the outer borders of the plaque perpendicular to the axis of the ICA by the maximal luminal diameter of the distal ICA at a region unaffected by atherosclerosis using long-axis, high-resolution MRI.
  
  
  RESULTS
  The ER ratio of the atherosclerotic CA was significantly greater than that of normal physiological expansion (carotid bulb; p < 0.01). The ER ratio of symptomatic CA stenosis (median 1.94, interquartile range [IQR] 1.58-2.23) was significantly greater than that of asymptomatic CA stenosis (median 1.52, IQR 1.34-1.81; p = 0.0001). When the cutoff value of the ER ratio was set to 1.88, the sensitivity and specificity to detect symptoms were 0.6 and 0.78, respectively. The ER ratio of symptomatic patients was consistently high regardless of the degree of stenosis.
  
  
  CONCLUSIONS
  There was a significant correlation between ER ratio and ischemic symptoms. The ER ratio might be a potential indicator of vulnerable plaque, which requires further validation by prospective observational study of asymptomatic patients.
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Kazumichi
authors: K
authors: Yoshida
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Ryu
authors: R
authors: Fukumitsu
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Yoshitaka
authors: Y
authors: Kurosaki
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Takeshi
authors: T
authors: Funaki
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Takayuki
authors: T
authors: Kikuchi
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Jun C
authors: JC
authors: Takahashi
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Yasushi
authors: Y
authors: Takagi
authors: Department of Neurosurgery, Kurashiki Central Hospital, Okayama, Japan.
authors: Sen
authors: S
authors: Yamagata
authors: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto; and.
authors: Susumu
authors: S
authors: Miyamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002343:Carotid Artery, Internal / Q000473:pathology* / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015607:Stents; D066253:Vascular Remodeling / Q000502:physiology*
keywords: CA = carotid artery; CAE = CA endarterectomy; CAS = CA stent placement; CI = confidence interval; ER = expansive remodeling; ICA = internal CA; IQR = interquartile range; NASCET = North American Symptomatic Carotid Endarterectomy Trial; OR = odds ratio; ROC = receiver operating characteristic; atherosclerosis; carotid stenosis; expansive remodeling; magnetic resonance imaging; vascular disorders; vulnerable plaque