Clinical significance of the internal carotid artery angle in ischemic stroke

Sang-Mi Noh,Hyun Goo Kang

doi:10.1038/s41598-018-37783-1

Sang-Mi Noh, Hyun Goo Kang

Open Access

https://doi.org/10.1038/s41598-018-37783-1

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Abstract

The carotid artery plays a major role in stroke aetiology and is a good indicator of atherosclerosis. However, the clinical significance of internal carotid artery (ICA) anatomy remains unclear in patients with ischaemic stroke. This study examined the relationship between ICA angle and risk of ischaemic stroke. ICA angles of patients with acute ischaemic stroke were retrospectively compared with those of control patients between March 2014 and July 2014. Controls consisted of those with headaches but without ischaemic stroke. In both groups, ICA angles were measured using Maximum Intensity Projection images from computed tomography angiography, and the relationship between ICA angle and risk of ischaemic stroke was analysed. Of 128 screened patients with acute ischaemic stroke, 27 were enrolled, and 29 with headache were enrolled as controls. No differences were found in baseline characteristics between the two groups, but intracranial stenosis was more frequent in patients with stroke than in controls. Bilateral ICA angles were significantly larger in patients with stroke than in controls. Multiple logistic regression models showed that the right ICA angle was associated with risk of ischaemic stroke. Measuring the ICA angle may help assess the risk of ischaemic stroke.

Highlights

Ischaemic stroke is one of the leading causes of morbidity and the most important cause of disability in adults
The internal carotid artery (ICA) and the external carotid arteries (ECA) are divided from the common carotid arteries (CCA), and an angle is formed between the two carotid arteries
We retrospectively investigated the medical records of inpatients with acute ischaemic strokes and those only with headache who underwent magnetic resonance image (MRI) or computed tomography (CT) angiography

Summary

Introduction

Ischaemic stroke is one of the leading causes of morbidity and the most important cause of disability in adults. Some studies suggested that the internal carotid artery (ICA) angle of origin could be a risk factor of early atherosclerosis[5]. The ICA and the ECA are divided from the CCA, and an angle is formed between the two carotid arteries. These angles lead to local hemodynamic stress in the ICA and carotid bulb, forming atherosclerotic plaque. Previous studies have reported the effects of the anatomy of the carotid artery on focal atherosclerosis[8]. It has not yet been studied whether carotid angle can be evaluated as a vascular risk factor reflecting systemic atherosclerosis. We did not evaluate the carotid angle as a risk factor for ipsilateral artery to artery embolic infarction, and compared the carotid angle in the ischaemic stroke and in the general population, excluding the cardioembolic stroke

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