Effects of carotid artery stenting on arterial geometry

Alexey Kamenskiy, Iraklis I Pipinos, Yuris Dzenis, Jai Bikhchandani, Prateek K. Gupta, Nick Phillips, Syed A Jaffar Kazmi, Jason N Mactaggart

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: The role of carotid artery stenting (CAS) for the treatment of carotid artery disease continues to evolve, despite higher stroke and restenosis risks for CAS compared with conventional open endarterectomy. Understanding the effects of CAS on arterial geometry, which strongly influence hemodynamics and wall mechanics, can assist in better stratifying the inherent risk of CAS to individual patients. Study Design: Fifteen consecutive patients undergoing CAS had pre- and post-stenting CT angiograms. These images were used to reconstruct the 3-dimensional geometries of the bilateral carotid arteries from their origin to the skull base. Quantitative assessment of the carotid bifurcation angle, cross-sectional area, tortuosity and artery length, were compared pre- and post-stenting. Plaque volume and calcification were also measured. Mathematical models were devised to determine the mechanisms of CAS-induced geometric changes, and their mechanical and hemodynamic significances. Results: Major and moderate changes in arterial tortuosity and elongation were seen in 5 (33%) patients. Characteristics most associated with the development of CAS-induced geometric changes were stenoses located in the internal carotid artery distal to the carotid bulb, circumferential distribution of plaque, and plaque calcification. Modeling did not demonstrate substantial alterations in wall shear stress due to geometric changes, but did show considerable increases in arterial wall axial stress. Conclusions: Cartoid artery stenting can produce geometric changes to the artery that promote favorable conditions for complications and recurrent disease. Patients with circumferential, highly calcified plaques that are located relatively distal in the internal carotid artery are most likely to have post-stenting geometric changes.

Original languageEnglish (US)
Pages (from-to)251-262
Number of pages12
JournalJournal of the American College of Surgeons
Volume217
Issue number2
DOIs
StatePublished - Aug 2013

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Carotid Arteries
Arteries
Internal Carotid Artery
Hemodynamics
Endarterectomy
Carotid Artery Diseases
Skull Base
Mechanics
Angiography
Pathologic Constriction
Theoretical Models
Stroke

Keywords

  • 3-dimensional
  • 3D
  • CAS
  • CCA
  • CEA
  • ECA
  • HMM-1
  • Hemodynamic Mathematical Model
  • ICA
  • NASCET
  • North American Symptomatic Carotid Endarterectomy Trial
  • PMM-II
  • Parametric Mathematical Model
  • WSS
  • carotid artery stenting
  • carotid endarterectomy
  • common carotid artery
  • external carotid artery
  • internal carotid artery
  • wall shear stress

ASJC Scopus subject areas

  • Surgery

Cite this

Effects of carotid artery stenting on arterial geometry. / Kamenskiy, Alexey; Pipinos, Iraklis I; Dzenis, Yuris; Bikhchandani, Jai; Gupta, Prateek K.; Phillips, Nick; Kazmi, Syed A Jaffar; Mactaggart, Jason N.

In: Journal of the American College of Surgeons, Vol. 217, No. 2, 08.2013, p. 251-262.

Research output: Contribution to journalArticle

Kamenskiy, Alexey ; Pipinos, Iraklis I ; Dzenis, Yuris ; Bikhchandani, Jai ; Gupta, Prateek K. ; Phillips, Nick ; Kazmi, Syed A Jaffar ; Mactaggart, Jason N. / Effects of carotid artery stenting on arterial geometry. In: Journal of the American College of Surgeons. 2013 ; Vol. 217, No. 2. pp. 251-262.
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abstract = "Background: The role of carotid artery stenting (CAS) for the treatment of carotid artery disease continues to evolve, despite higher stroke and restenosis risks for CAS compared with conventional open endarterectomy. Understanding the effects of CAS on arterial geometry, which strongly influence hemodynamics and wall mechanics, can assist in better stratifying the inherent risk of CAS to individual patients. Study Design: Fifteen consecutive patients undergoing CAS had pre- and post-stenting CT angiograms. These images were used to reconstruct the 3-dimensional geometries of the bilateral carotid arteries from their origin to the skull base. Quantitative assessment of the carotid bifurcation angle, cross-sectional area, tortuosity and artery length, were compared pre- and post-stenting. Plaque volume and calcification were also measured. Mathematical models were devised to determine the mechanisms of CAS-induced geometric changes, and their mechanical and hemodynamic significances. Results: Major and moderate changes in arterial tortuosity and elongation were seen in 5 (33{\%}) patients. Characteristics most associated with the development of CAS-induced geometric changes were stenoses located in the internal carotid artery distal to the carotid bulb, circumferential distribution of plaque, and plaque calcification. Modeling did not demonstrate substantial alterations in wall shear stress due to geometric changes, but did show considerable increases in arterial wall axial stress. Conclusions: Cartoid artery stenting can produce geometric changes to the artery that promote favorable conditions for complications and recurrent disease. Patients with circumferential, highly calcified plaques that are located relatively distal in the internal carotid artery are most likely to have post-stenting geometric changes.",
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AU - Dzenis, Yuris

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AU - Gupta, Prateek K.

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AB - Background: The role of carotid artery stenting (CAS) for the treatment of carotid artery disease continues to evolve, despite higher stroke and restenosis risks for CAS compared with conventional open endarterectomy. Understanding the effects of CAS on arterial geometry, which strongly influence hemodynamics and wall mechanics, can assist in better stratifying the inherent risk of CAS to individual patients. Study Design: Fifteen consecutive patients undergoing CAS had pre- and post-stenting CT angiograms. These images were used to reconstruct the 3-dimensional geometries of the bilateral carotid arteries from their origin to the skull base. Quantitative assessment of the carotid bifurcation angle, cross-sectional area, tortuosity and artery length, were compared pre- and post-stenting. Plaque volume and calcification were also measured. Mathematical models were devised to determine the mechanisms of CAS-induced geometric changes, and their mechanical and hemodynamic significances. Results: Major and moderate changes in arterial tortuosity and elongation were seen in 5 (33%) patients. Characteristics most associated with the development of CAS-induced geometric changes were stenoses located in the internal carotid artery distal to the carotid bulb, circumferential distribution of plaque, and plaque calcification. Modeling did not demonstrate substantial alterations in wall shear stress due to geometric changes, but did show considerable increases in arterial wall axial stress. Conclusions: Cartoid artery stenting can produce geometric changes to the artery that promote favorable conditions for complications and recurrent disease. Patients with circumferential, highly calcified plaques that are located relatively distal in the internal carotid artery are most likely to have post-stenting geometric changes.

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