Atherosclerotic Carotid Stenoses of Apical versus Body Lesions in High-Risk Carotid Stenting Patients

• Published in: American journal of neuroradiology : AJNR Vol. 31; no. 6; pp. 1106 - 1112
• Main Authors: PARK, S.-T, KIM, J. K, YOON, K. H, PARK, S.-O, PARK, S. W, KIM, J. S, KIM, S. J, SUH, D. C
• Format: Journal Article
• Language: English
• Published: Oak Brook, IL American Society of Neuroradiology 01-06-2010
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carotid Arteries - diagnostic imaging; Carotid Arteries - surgery; Carotid Artery Diseases - epidemiology; Carotid Artery Diseases - surgery; Carotid Artery Diseases - therapy; Carotid Stenosis - epidemiology; Carotid Stenosis - surgery; Carotid Stenosis - therapy; Cerebral Angiography; Cerebral Infarction - epidemiology; Cerebral Infarction - pathology; Electrocardiography. Vectocardiography; Electrodiagnosis. Electric activity recording; Endarterectomy, Carotid; Female; Humans; Hyperlipidemias - epidemiology; Interventional; Investigative techniques, diagnostic techniques (general aspects); Logistic Models; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Retrospective Studies; Risk Factors; Stents; Human; High risk; Nervous system diseases; Radiodiagnosis; Blood vessel; Carotid; Circulatory system; Artery; Comparative study
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A2000

Different lesion locations in the atherosclerotic carotid bulb stenosis have not been clearly defined. We sought to evaluate 2 locations of carotid bulb stenosis in high-risk patients and to determine the relationship of each location to atherosclerotic risk factors and clinical features.
Atherosclerotic carotid plaques of apical versus body lesions, defined according to the area and extent of plaque involvement, were retrospectively analyzed in 200 consecutive high-risk patients who underwent carotid stent placement because of > or =50% symptomatic stenosis. We evaluated interobserver concordance and assessed each type of lesion relative to 13 atherosclerotic risk factors, mode of symptom presentation, infarct pattern, procedure-related factors, and clinical outcomes, by univariate and multivariable logistic regression analysis.
Interobserver concordance showed good agreement for differentiating apical and body lesions (kappa = 0.745). Univariate analysis revealed that apical lesions (n = 108, 54%) were associated with pseudo-occlusion (P = .027), older age (P = .073), and alcohol intake (P = .080), whereas body lesions (n = 92, 46%) were associated with hyperlipidemia (P = .001), a wedge-shaped cortical infarct pattern (P = .057), and hyperperfusion syndrome (P = .083). Multivariable logistic regression analysis adjusted by age revealed that hyperlipidemia (P = .002; OR, 3.462; 95% CI, 1.595-7.515) and hyperperfusion (P = .026; OR, 6.727; 95% CI, 1.261-35.894) were independent predictors of body-type lesions.
Atherosclerotic carotid bulb stenosis was found to have 2 distinct locations, body and apical. Hyperlipidemia and cortical wedge-shaped infarcts were more frequently associated with body than with apical stenosis at the time of presentation.