Skip to main content
SpringerLink
Log in

Wall shear stress distribution at the carotid bifurcation: influence of eversion carotid endarterectomy

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To test the feasibility of four-dimensional (4D) flow MRI to quantify the systolic wall shear stress (WSSsystole) and oscillatory shear index (OSI) in high-grade internal carotid artery (ICA) stenosis before and after endarterectomy (CEA).

Methods

Twenty patients with ≥60 % ICA stenosis were prospectively and consequently included. Four-dimensional flow MRI was used to measure individual time-resolved 3D blood flow velocities. Segmental WSSsystole and OSI were derived at eight wall segments in analysis planes positioned along the ICA, common (CCA) and external carotid artery (ECA).

Results

Regional WSSsystole of all patients decreased after CEA (P < 0.05). Changes were most prominent at the ICA bulb but remained unchanged in the CCA and ECA. OSI was significantly lower after CEA in the lateral vessel walls (P < 0.05). For analysis planes at the stenosis in- and outlet, a reduction of mean WSSsystole by 32 % and 52 % (P < 0.001) and OSI distal to the stenosis (40 %, P = 0.01) was found after CEA.

Conclusions

Our findings show the potential of in vivo 4D flow MRI to quantify haemodynamic changes in wall shear stress even in patients with complex flow conditions.

Key Points

• The 4D flow MRI allows in vivo measurement of individual 3D blood flow.

• Regional wall shear stress can be derived from such 3D flow data.

• Even complex flow in high-grade internal carotid artery stenosis can be analysed.

• This technique could be valuable for future studies of carotid atherosclerosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Brott TG, Hobson RW 2nd, Howard G et al (2010) Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 363:11–23

    Article  PubMed  CAS  Google Scholar 

  2. Harloff A, Zech T, Wegent F, Strecker C, Weiller C, Markl M (2013) Comparison of blood flow velocity quantification by 4D flow MR imaging with ultrasound at the carotid bifurcation. AJNR Am J Neuroradiol. doi:10.3174/ajnr.A3419

    PubMed  Google Scholar 

  3. Sachar R, Yadav JS, Roffi M et al (2004) Severe bilateral carotid stenosis: the impact of ipsilateral stenting on Doppler-defined contralateral stenosis. J Am Coll Cardiol 43:1358–1362

    Article  PubMed  Google Scholar 

  4. Aleksic M, Matoussevitch V, Heckenkamp J, Brunkwall J (2006) Changes in internal carotid blood flow after CEA evaluated by transit-time flowmeter. Eur J Vasc Endovasc Surg 31:14–17

    Article  PubMed  CAS  Google Scholar 

  5. Malek AM, Alper SL, Izumo S (1999) Hemodynamic shear stress and its role in atherosclerosis. JAMA 282:2035–2042

    Article  PubMed  CAS  Google Scholar 

  6. Cheng C, Tempel D, van Haperen R et al (2006) Atherosclerotic lesion size and vulnerability are determined by patterns of fluid shear stress. Circulation 113:2744–2753

    Article  PubMed  Google Scholar 

  7. Tomita H, Hagaman J, Friedman MH, Maeda N (2012) Relationship between hemodynamics and atherosclerosis in aortic arches of apolipoprotein E-null mice on 129S6/SvEvTac and C57BL/6J genetic backgrounds. Atherosclerosis 220:78–85

    Article  PubMed  CAS  Google Scholar 

  8. Lee SW, Antiga L, Spence JD, Steinman DA (2008) Geometry of the carotid bifurcation predicts its exposure to disturbed flow. Stroke 39:2341–2347

    Article  PubMed  Google Scholar 

  9. Markl M, Wegent F, Zech T et al (2010) In vivo wall shear stress distribution in the carotid artery: effect of bifurcation geometry, internal carotid artery stenosis, and recanalization therapy. Circ Cardiovasc Imaging 3:647–655

    Article  PubMed  Google Scholar 

  10. European Carotid Surgery Trialists’ Collaborative Group (1991) MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 337:1235–1243

    Article  Google Scholar 

  11. Harloff A, Albrecht F, Spreer J et al (2009) 3D blood flow characteristics in the carotid artery bifurcation assessed by flow-sensitive 4D MRI at 3T. Magn Reson Med 61:65–74

    Article  PubMed  CAS  Google Scholar 

  12. Bock J, Kreher BW, Hennig J, Markl M (2007) Optimized pre-processing of time-resolved 2D and 3D phase contrast MRI data. Abstract. ISMRM May; Berlin, Germany. p 3138

  13. Bock J, Frydrychowicz A, Stalder AF et al (2010) 3D phase contrast MRA and flow visualization in the thoracic aorta at 3T: feasibility and effect of standard and blood-pool contrast agents. Magn Reson Med 63:330–338

    Article  PubMed  Google Scholar 

  14. Stalder AF, Russe MF, Frydrychowicz A, Bock J, Hennig J, Markl M (2008) Quantitative 2D and 3D phase contrast MRI: optimized analysis of blood flow and vessel wall parameters. Magn Reson Med 60:1218–1231

    Article  PubMed  CAS  Google Scholar 

  15. Barker AJ, Markl M, Burk J et al (2012) Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging 5:457–466

    Article  PubMed  Google Scholar 

  16. Lal BK, Beach KW, Roubin GS et al (2012) Restenosis after carotid artery stenting and endarterectomy: a secondary analysis of CREST, a randomised controlled trial. Lancet Neurol 11:755–763

    Article  PubMed  Google Scholar 

  17. Markl M, Wallis W, Harloff A (2011) Reproducibility of flow and wall shear stress analysis using flow-sensitive four-dimensional MRI. J Magn Reson Imaging 33:988–994

    Article  PubMed  Google Scholar 

  18. LaDisa JF Jr, Bowers M, Harmann L et al (2010) Time-efficient patient-specific quantification of regional carotid artery fluid dynamics and spatial correlation with plaque burden. Med Phys 37:784–792

    Article  PubMed  Google Scholar 

  19. Hayase H, Tokunaga K, Nakayama T et al (2011) Computational fluid dynamics of carotid arteries after carotid endarterectomy or carotid artery stenting based on postoperative patient-specific computed tomography angiography and ultrasound flow data. Neurosurgery 68:1096–1101

    PubMed  Google Scholar 

  20. Harloff A, Markl M, Frydrychowicz A, Hennig J, Weiller C (2009) Diagnosing stroke aetiologies. Morphologic and functional analysis of the aorta and carotid arteries by MRI. Nervenarzt 80:929–940

    Article  PubMed  CAS  Google Scholar 

  21. Gallo D, Steinman DA, Bijari PB, Morbiducci U (2012) Helical flow in carotid bifurcation as surrogate marker of exposure to disturbed shear. J Biomech 45:2398–2404

    Article  PubMed  Google Scholar 

  22. Tate Q, Kim SE, Treiman G, Parker DL, Hadley JR (2012) Increased vessel depiction of the carotid bifurcation with a specialized 16-channel phased array coil at 3T. Magn Reson Med 69:1486–1493

    Article  PubMed  Google Scholar 

  23. Barker AJ, Lanning C, Shandas R (2010) Quantification of hemodynamic wall shear stress in patients with bicuspid aortic valve using phase-contrast MRI. Ann Biomed Eng 38:788–800

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Hansjörg Mast for performing all MRI measurements.

Andreas Harloff is supported by Deutsche Forschungsgemeinschaft grant no. HA 5399/3-1; Michael Markl is supported by NIH NHLBI grant R01HL115828; NUCATS Institute NIH grant UL1RR025741, and the Northwestern Memorial Foundation Dixon Translational Research Grants Initiative.

Disclosures

None of the authors has a conflict of interest related to this article.

Author information

Authors and Affiliations

  1. Department of Neurology, University Hospital Freiburg, Breisacher Strasse 64, 79106, Freiburg, Germany

    A. Harloff, S. Berg & C. Weiller

  2. Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    A. J. Barker & M. Markl

  3. Department of Biomedical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA

    M. Markl

  4. Department of Cardiothoracic Surgery, University Hospital Freiburg, Freiburg, Germany

    J. Schöllhorn

  5. Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany

    M. Schumacher

Authors
  1. A. Harloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Berg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. J. Barker
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Schöllhorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Schumacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Weiller
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Markl
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Harloff.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Harloff, A., Berg, S., Barker, A.J. et al. Wall shear stress distribution at the carotid bifurcation: influence of eversion carotid endarterectomy. Eur Radiol 23, 3361–3369 (2013). https://doi.org/10.1007/s00330-013-2953-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-013-2953-4

Keywords

Search

Navigation