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Research ArticleNeurovascular/Stroke Imaging

High Wall Shear Stress Is Related to Complicated American Heart Association Lesion Type VI Plaques in Mild-to-Moderate ICA Stenosis: A 3D Cardiovascular MRI Study

Christoph Strecker, Axel Joachim Krafft, Tobias Saam, Markus Huellebrand, Ute Ludwig, Anja Hennemuth, Jürgen Hennig and Andreas Harloff
American Journal of Neuroradiology May 2025, 46 (5) 879-886; DOI: https://doi.org/10.3174/ajnr.A8583
Christoph Strecker
aFrom the Department of Neurology and Neurophysiology (C.S., A.H.), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Axel Joachim Krafft
bDepartment of Radiology (A.J.K., U.L., J.H.), Medical Physics Medical Center: Faculty of Medicine, University of Freiburg, Freiburg, Germany
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  • ORCID record for Axel Joachim Krafft
Tobias Saam
cDie Radiologie (T.S.), Rosenheim, Germany
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Markus Huellebrand
dDeutsches Herzzentrum der Charité (M.H., A.H.), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
eCharité (M.H., A.H.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
fFraunhofer Institute for Digital Medicine Motion expressions Video Segmentation (MeViS) (M.H., A.H.), Berlin, Germany
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Ute Ludwig
bDepartment of Radiology (A.J.K., U.L., J.H.), Medical Physics Medical Center: Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Anja Hennemuth
dDeutsches Herzzentrum der Charité (M.H., A.H.), Institute of Computer-assisted Cardiovascular Medicine, Berlin, Germany
eCharité (M.H., A.H.), Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
fFraunhofer Institute for Digital Medicine Motion expressions Video Segmentation (MeViS) (M.H., A.H.), Berlin, Germany
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Jürgen Hennig
bDepartment of Radiology (A.J.K., U.L., J.H.), Medical Physics Medical Center: Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Andreas Harloff
aFrom the Department of Neurology and Neurophysiology (C.S., A.H.), Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abstract

BACKGROUND AND PURPOSE: Complicated American Heart Association (AHA) lesion type VI plaques and cCAPs, characterized by the presence of intraplaque hemorrhage and a surface defect or thrombus, are strongly associated with ischemic stroke and stroke recurrence. Hemodynamics seem to play a relevant role in their development. Thus, we investigated the association of 4D-flow MRI-derived local wall shear stress (WSS) and the oscillatory shear index (OSI) with the presence of cCAPs in patients with mild-to-moderate ICA stenosis.

MATERIALS AND METHODS: From a prospective and consecutive cross-sectional study with 121 patients with high cardiovascular risk, 39 patients (49 carotid arteries) demonstrated a 10%–50% ICA stenosis and were included in this analysis. Plaque composition was determined according to the modified AHA classification of lesions by high-resolution multicontrast 3T MRI. We determined WSS (minimum, mean, and maximum) and the OSI in vivo by 4D-flow MRI at different locations within the stenosis (upstream, stenosis center, and downstream). We studied the association of each hemodynamic parameter with the presence cCAPs by logistic regression analysis adjusted for age, sex and plaque thickness.

RESULTS: Eleven (22.4%) of the 49 cases of ICA stenosis in our cohort showed cCAP. WSS and OSI at the beginning of the stenosis did not differ between complicated and stable plaques. By contrast, WSS was significantly higher in the stenosis center and poststenotic region in cCAPs. OSI was significantly higher in the stenosis center of stable plaques. Logistic regression analysis revealed a significant association for WSSmean (OR per SD increase, 1.97; 95% CI, 1.14–3.39, P = .015) and for WSSmaximum (OR per SD increase, 1.84; 95% CI, 1.10–3.08, P = .020), but not for WSSminimum and OSI with the presence of cCAPs.

CONCLUSIONS: Higher WSS in ICA stenosis was significantly associated with the presence of cCAPs, underlining the potential role of hemodynamics in their development.

ABBREVIATIONS:

AHA
American Heart Association
BW
bandwidth
cCAP
complicated carotid artery plaque
CFD
computational fluid dynamics
OSI
oscillatory shear index
TA
acquisition time
WSS
wall shear stress
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American Journal of Neuroradiology: 46 (5)
American Journal of Neuroradiology
Vol. 46, Issue 5
1 May 2025
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Cite this article
Christoph Strecker, Axel Joachim Krafft, Tobias Saam, Markus Huellebrand, Ute Ludwig, Anja Hennemuth, Jürgen Hennig, Andreas Harloff
High Wall Shear Stress Is Related to Complicated American Heart Association Lesion Type VI Plaques in Mild-to-Moderate ICA Stenosis: A 3D Cardiovascular MRI Study
American Journal of Neuroradiology May 2025, 46 (5) 879-886; DOI: 10.3174/ajnr.A8583

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High Wall Shear Stress and Complicated Plaques
Christoph Strecker, Axel Joachim Krafft, Tobias Saam, Markus Huellebrand, Ute Ludwig, Anja Hennemuth, Jürgen Hennig, Andreas Harloff
American Journal of Neuroradiology May 2025, 46 (5) 879-886; DOI: 10.3174/ajnr.A8583
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