Carotid Artery Stiffness: Imaging Techniques and Impact on Cerebrovascular Disease

Hediyeh Baradaran,Ajay Gupta

doi:10.3389/fcvm.2022.852173

Hediyeh Baradaran, Ajay Gupta

Open Access

https://doi.org/10.3389/fcvm.2022.852173

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Abstract

Arterial stiffness is an important measure of vascular aging and atherosclerosis. Though it is measured in many well-known epidemiologic cohort studies, arterial stiffness is often overlooked in routine clinical practice for a number of reasons including difficulties in measurement, variations in definition, and uncertainties surrounding treatment. Central arterial stiffness, a surrogate for aortic stiffness, is the most commonly measured marker of arterial stiffness. In addition to central stiffness, there are also a number of ultrasound based techniques to measure local vascular stiffness, including carotid stiffness. There is evidence that both local carotid stiffness and central arterial stiffness measures are associated with multiple cerebrovascular processes, including stroke and cognitive dysfunction. Mechanistic explanations supporting this association include increased flow load experienced by the cerebral microvasculature leading to cerebral parenchymal damage. In this article, we review definitions of carotid artery stiffness measures and pathophysiologic mechanisms underpinning its association with plaque development and downstream cerebral pathology. We will review the evidence surrounding the association of carotid stiffness measures with downstream manifestations including stroke, cerebral small vessel disease detected on brain MR such as white matter hyperintensities and covert brain infarctions, brain atrophy, and cognitive dysfunction. With consistent definitions, measurement methods, and further scientific support, carotid stiffness may have potential as an imaging-based risk factor for stroke and cognitive decline.

Highlights

Diseases of the carotid artery are a major cause of worldwide morbidity and mortality, with carotid atherosclerosis accounting for nearly 1 in 5 acute ischemic strokes [1]
A recent cohort study found that higher central arterial stiffness was associated with cognitive dysfunction and that association was in part mediated by markers of cerebral small vessel disease on brain magnetic resonance (MR) [59]
Having increased carotid stiffness is associated with multiple downstream effects including cardiovascular disease, stroke, and cognitive dysfunction

Summary

Introduction

Diseases of the carotid artery are a major cause of worldwide morbidity and mortality, with carotid atherosclerosis accounting for nearly 1 in 5 acute ischemic strokes [1]. Carotid-femoral PWV (cfPWV) is often considered the gold standard of measuring central artery stiffness and is recommended by the American Heart Association with the highest level of supporting evidence as a method for evaluating arterial stiffness [13]. This end-organ damage may manifest in a number of ways including stroke, cognitive dysfunction, or cerebral small vessel disease evident on brain imaging (Figure 2) [22].

Results

Conclusion