Internal Carotid Artery Bifurcation Research Articles

Triplicated middle cerebral arteries (duplicated and ipsilateral accessory) associated with triplicated anterior cerebral arteries (accessory) diagnosed by magnetic resonance angiography.

To describe a case of duplicated middle cerebral artery (MCA) combined with ipsilateral accessory MCA, forming a triplicated MCA, associated with the accessory anterior cerebral artery (ACA), forming a triplicated A2 segment of the ACA detected incidentally on magnetic resonance (MR) angiography. A 70-year-old woman with internal carotid artery (ICA) stenosis at the origin, which was detected by ultrasound, underwent cranial MR imaging and MR angiography of the intracranial region for an evaluation of brain and cerebral arterial lesions. The MR machine was a 3-Tesla scanner. MR angiography was performed using a standard 3-dimensional time-of-flight technique. Multiple ischemic white matter lesions are observed. No significant stenotic lesions were observed in intracranial arteries. The right duplicated MCA was originated from right distal ICA. And main MCA was originated from right ICA bifurcation. Right accessory MCA was arisen from the A2 segment of the right ACA. Thus, the right MCA was triplicated. There was also an accessory ACA forming a triplicated ACA at its A2 segment. These findings were clearly identified on partial volume-rendering (VR) images. We herein report a case of triplicated MCA associated with triplicated ACA. MCA variations are relatively rare, and this is the third case of triplicated MCA reported in relevant English-language literature. To identify multiple cerebral arterial variations, creating partial VR images using MR angiographic source images is useful.

Recurrent Artery of Heubner Guiding the Clip Application for Internal Carotid Artery Bifurcation Aneurysm: 2-Dimensional Operative Video.

Aneurysms of the bifurcation of the internal carotid artery (ICA) represent approximately 5% of intracranial aneurysms and tend to occur in younger patients.1-3 They typically have a superior orientation, in close relationship with the medial (branches of the anterior cerebral artery, segment A1) and lateral (branches of the middle cerebral artery, segment M1) lenticulostriate arteries (LSA), including recurrent artery of Heubner (RAH). RAH commonly originates in the junction of A1 and A2, courses medially to laterally between LSA and anterior cerebral artery, ICA bifurcation, and middle cerebral artery before entering the lateral portion of the anterior perforated substance.4-7 Damage to these arteries are catastrophic. This complex vascular anatomy makes treatment challenging, either endovascular or microsurgical.8-13 We present a video case of microsurgical clipping for the left ICA bifurcation aneurysm. This study was approved by the ethics committee of our institution. The patient, a 46-year-old man, was diagnosed with an unruptured ICA bifurcation aneurysm during workup for intermittent headache. Morphological characteristics of the aneurysm supported intervention over conservative treatment. Digital subtraction angiography showed a prominent proximal RAH crossing between the aneurysm neck and LSA, providing anatomical protection for clip application. Microsurgical clipping was chosen, and the procedure went uneventfully. The patient consented to the procedure and to the publication of his/her image. We discussed and demonstrated throughout the video how we used this anatomic variation and trajectory of the RAH to prevent clipping of LSA unwittingly and achieve complete occlusion of the aneurysm neck.

Assessing Radiation Exposure and Contrast Agent Utilization: A Comparative Analysis of the Woven EndoBridge Device and Stent-Assisted Coil Embolization for Managing Unruptured Wide-Neck Bifurcation Aneurysms.

In this study, we determined whether there were significant differences in procedure time, radiation dose, fluoroscopy time, and total contrast media dose when unruptured wideneck bifurcation aneurysms (WNBAs) were treated with the Woven EndoBridge (WEB) device and stent-assisted coil (SAC) embolization. The WEB device and SAC embolization (14:17) were used to treat 31 cases of internal carotid artery bifurcation, anterior communicating artery, middle cerebral artery bifurcation, and basilar bifurcation aneurysms between August 2021 and December 2022. The procedure time, radiation dose, fluoroscopy time, and total contrast medium dose between the 2 treatment groups were compared and analyzed. In the WEB device group, the results between operators were compared, and the follow-up radiologic outcomes were investigated. The procedure and fluoroscopy times were significantly shorter in the WEB device group. Radiation and total contrast media dose were also significantly smaller in the WEB device, but there was no significant difference in results between operators. The follow-up radiological outcome showed adequate occlusion in 83.3% (10/12) of cases. The WEB device can be used as an alternative treatment method among the available endovascular treatment methods for WNBAs to reduce radiation exposure and the dose of contrast media when used adequately with appropriate indications.

Coil entrapment in temporary stent-assisted coiling of wide-neck aneurysm: a case report

Abstract Background Endovascular treatment of the wide-necked aneurysm is still challenging. Temporary stent-assisted coiling (TSAC) was introduced to manage the ruptured wide-necked aneurysms to avoid the long-term use of dual antiplatelets as well as improving aneurysm filling with coils. Case presentation Here, we reported a case of the coil entrapment into the stent device during TSAC for the treatment of a wide-necked large ruptured aneurysm. Patient presented with loss of consciousness following diffuse subarachnoid hemorrhage due to a wide-necked large aneurysm located in the left ICA bifurcation. During treatment of aneurysm with TSAC technique, the stent could not retrieve and re-sheath because of coil entrapment in the stent struts. Consequently, the stent was released by cutting the pushing wire at the puncture site. Conclusion Entrapment of coils in the stent struts is a very rare technical complication of TSAC method. It is essential to be aware of this side effect and how to avoid.

Endovascular treatment of intracranial internal carotid artery bifurcation region aneurysms.

Intracranial internal carotid artery (ICA) bifurcation region aneurysms are uncommon. When treatment is necessary for ICA, endovascular treatment (EVT) can be a useful option. Due to the complexity of these aneurysms and the variability of EVT techniques, EVT for ICA bifurcation aneurysms is challenging. Currently, it is necessary to perform a review to explore this issue further. In this review, the following issues were discussed: the anatomy of the ICA bifurcation region; the classification, natural history and EVT status of ICA bifurcation region aneurysms; the technique used for identifying ICA bifurcation region aneurysms; and the prognosis and complications of EVT for ICA bifurcation region aneurysms. According to the review and our experience, traditional coiling is currently the preferred therapy for ICA bifurcation region aneurysms. In addition, in select cases, new devices, such as flow diverters and Woven EndoBridge devices, can also be used to treat ICA bifurcation region aneurysms. Generally, EVT is an alternative treatment option for ICA bifurcation region aneurysms.

Microsurgical Management of Internal Carotid Artery Bifurcation Aneurysm After Failure of Endovascular Coiling and Flow Diversion: 2-Dimensional Operative Video.

We describe the case of a 51-year-old woman who underwent craniotomy and surgical clipping of a large internal carotid bifurcation aneurysm that was refractory to treatment with 2 rounds of endovascular coiling and internal carotid artery (ICA) to middle cerebral artery pipeline placement. The patient initially presented in 2004 with a 3-week history of sudden-onset headache with associated nausea. Computed tomography and lumbar puncture on presentation in 2004 were negative for subarachnoid hemorrhage. Digital subtraction angiography, however, demonstrated a large left ICA bifurcation aneurysm. The decision was made to proceed with endovascular coiling of the aneurysm. Six-month and 1-year follow-up imaging showed incomplete resolution of the aneurysm, and retreatment coiling was completed in 2005. After recoiling in 2005, the patient was lost to follow-up. During this period, she underwent pipeline placement from the ICA to the middle cerebral artery across the A1 segment at a different institution. Two years after flow diversion, the patient was referred back to our institution with further worsening of the aneurysm. Our surgical team opted for craniotomy and surgical clipping given the limited management options that this extremely complex case now presented. The patient consented to the procedure. Postoperative imaging demonstrated marked improvement in aneurysm severity. Although the current neurosurgical trend favors endovascular treatment over craniotomy, this case shows the vital importance of craniotomy and aneurysm clipping in the treatment of select patients. We also provide high-quality operative video of aneurysm clipping.1-7.

Anterior circulation location-specific results for stent-assisted coiling – carotid versus distal aneurysms: 1-year outcomes from the Neuroform Atlas Stent Pivotal Trial

BackgroundThe Neuroform Atlas Stent System is an established treatment modality for unruptured anterior and posterior circulation intracranial aneurysms. Location-specific results are needed to guide treatment decision-making. However, it is unclear...

Association between Carotid Bifurcation Angle and Vulnerable Plaque Volume Using Black Blood Magnetic Resonance Imaging.

The morphology of the internal carotid artery (ICA) bifurcation is increasingly being recognized as the cause of atherosclerosis and vulnerable plaque leading to cerebral infarction. In this study, we investigated the relationship between carotid bifurcation angle and carotid plaque volume evaluated using black blood magnetic resonance imaging (BB-MRI). Among the 90 patients who underwent revascularization for atherosclerotic symptomatic carotid stenosis between April 2016 and October 2022 using BB-MRI, carotid plaque was evaluated in 57 patients. Relative overall signal intensity (roSI) was defined as the signal intensity of the plaque on T1-weighted images relative to the signal intensity of the sternocleidomastoid muscle in the same slice as the common carotid bifurcation. Regions showing roSI ≥ 1.0 were defined as plaque, and the plaque volume and relative plaque volume were measured from roSI ≥1.0 to ≥2.0 in 0.1 increments. We calculated the angles between the common carotid artery (CCA) and the ICA and between the CCA and the external carotid artery (ECA) on magnetic resonance angiography. We classified two groups according to carotid bifurcation angles based on the ICA angle: Group A = <35° and Group B = ≥35°. Compared with Group A (n = 42), Group B (n = 15) showed a greater relative plaque volume between roSI ≥ 1.3 and roSI ≥ 1.5. A significant correlation was identified between relative plaque volume with roSI ≥ 1.4 and ICA angle (p = 0.049). Vulnerable plaque was significantly more frequent in the group with an ICA angle of ≥35. Moreover, the ICA angle was significantly greater in patients with a roSI of ≥1.4.

Three-Dimensional Morphometric Analysis of Anterior Cerebral Circulation Aneurysms.

This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; p = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; p = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; p = 0.012), ICA bifurcation angle (OR = 1.02; p = 0.036), and length of the carotid siphon (OR = 1.08; p = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.

Strategy of cerebral endovascular treatment for cervical internal carotid artery stenosis with a persistent primitive hypoglossal artery.

Persistent primitive hypoglossal artery (PPHA) is a rare residual arterial anastomosis. We placed a CASPER stent using Spider FX as an embolic protection device (EPD) in a patient with internal carotid artery (ICA) stenosis and PPHA. There are no reports of carotid artery stenting (CAS) using a CASPER stent for ICA stenosis with PPHA. We report the EPD strategy used in this case and the usefulness and precautions of CASPER stent insertion for cervical ICA stenosis in association with PPHA. A 9Fr sheath was placed in the right femoral artery and a 9Fr Branchor balloon guide catheter was guided to the common carotid artery. A Spider FX was placed proximal to the bifurcation of the ICA and the PPHA. A 10 mm × 20 mm CASPER stent was deployed at the site of the stricture with no postoperative ischemic complications. There was no intra-stent occlusion, stenosis, or plaque protrusion immediately after surgery, and no postoperative ischemic complications were observed. CASPER stent deployment with the Spider FX in the ICA and PPHA bifurcation can be considered to be an effective treatment method for ICA stenosis associated with PPHA. However, care should be taken in selecting the appropriate EPDs and stents depending on the location of the stenosis and bifurcation of the PPHA.

Endo Vascular Management of Supra and Infra Tentorial Pediatric Intracranial Aneurysms; A Single Center Experience

Intracranial aneurysms are rare in pediatric population. They have different pathophysiology, location, type, outcome than adults. Long life expectancy, denovo occurrence and their tendency to recur necessitate the long term follow up in these cases. Here we summarize our experience in treating these aneurysms in a tertiary care hospital from 2014 to 2021. We found 4% of our total aneurysm population to be under 18 years with a male to female ratio of 1.5:1. 13.3% patients had multiple aneurysms and 38.9% had posterior circulation aneurysms. Most common site of aneurysm was ICA bifurcation. Most of the patients were treated endovascularly with favorable outcome at follow up

Intracerebral hemorrhage and ischaemic stroke due to Moyamoya disease in young patients: a case report

Link of Video Abstract: https://youtu.be/DWVi34rPNOg Background: Moyamoya disease (MMD) is a non-atherosclerotic cerebrovascular disorder characterized by progressive stenosis of the distal part of the internal carotid artery (ICA), thus forming an abnormal vascular network in the base of the brain. MMD is often found in women. The common symptoms of MMD are migraine, epilepsy, recurrent transient ischemic attack (TIA), ischemic stroke, and intracerebral hemorrhage. Stroke at young onset has challenges in looking for risk factors and etiology. A detailed examination is needed to prevent recurrent strokes. Case Presentation: Male 17-year-old complained of a throbbing headache on the right side for 5 months, with a numeric rating scale (NRS) 4. The headache duration was 24-72 hours, with a frequency of 1-2 times a month. Complaints are exacerbated by activity and improve when taking over medication. 2 months after the first onset, he felt severe headache with NRS 7, accompanied by weakness and tingling on the left side. All his laboratory results were within normal limits. Cerebral Digital Subtraction Angiography (DSA) results showed severe stenosis at the base of the right ICA bifurcation segment accompanied by slow flow at the right middle cerebral artery (MCA) and severe stenosis at the base of the left ICA accompanied by cross-filling to the contralateral anterior cerebral artery (ACA). Cortico-cortical collaterals were obtained from the posterior cerebral artery (PCA) branch covering the MCA area. The patient was diagnosed with MMD. Conclusion: MMD is a rare cerebrovascular disease that can be a risk factor for stroke at a young age. Diagnosis and evaluation of the collateral system need to be carried out through cerebral angiography so that the selection and consideration of appropriate management of recurrent stroke attacks can be carried out.

Numerical modeling of varying hemodynamic features with changing internal carotid artery bifurcation angles and degrees of stenosis

Atherosclerosis is a disease clinically categorized as a silent killer as its symptoms only become pronounced after the buildup has extensively progressed. Therefore, early detection, prediction and treatment become of great priority. The focus of this study is to develop a deeper understanding of plaque formation and the role of key structural variations, specifically the bifurcation angle and degree of stenosis, on its progression in a numerical carotid artery model. A two-way coupled Fluid–Solid Interaction (FSI) numerical approach has been implemented, with the consideration of isotropic elasticity for the artery wall. Geometrically induced hemodynamic flow variations were monitored by tracking changes in hemodynamic indicators, such as the wall shear stress (WSS) and vortex structures. The numerical results demonstrate general trends of the bifurcation angle amplifying recirculation zones, reducing WSS at the sinus far walls, and inhibiting wall deformations about the apex. Meanwhile, progressive stenosis is shown to induce new vortices, increase and decrease WSS at the outer walls and the inner walls respectively, and promote larger deformations. These hemodynamic flow and structural variations hint at increased risk of further plaque buildup with the increase of bifurcation angle at lower degrees of stenosis, while an increased risk of plaque rupture was associated with higher degrees of stenosis.

Abstract Number ‐ 67: A case of Carotid blowout syndrome, case report, and review.

Introduction Carotid blowout syndrome (CBS) is a potentially fatal carotid artery rupture. It is an unforeseen complication during mechanical thrombectomy that can be catastrophic without timely diagnosis and intervention. CBS develops when a damaged arterial wall cannot sustain its integrity, especially in patients who have undergone surgery or radiotherapy due to cancer. Carotid blowout syndrome is classified as threatened (type1), impending (type2), and acute (type3). Endovascular techniques have emerged as preferable alternatives to surgical ligation for treatment of CBS. Previous systemic reviews and meta‐analyses demonstrated that both coil embolization and stent grafting may be safe treatment options for CBS. This case study aims to show that early detection and endovascular management with transient distal balloon occlusion and stenting are lifesaving measures. Methods Case‐report Results Case presentation: 60‐year‐old male with past medical history of lung cancer s/p chemotherapy and radiation, hypertension, and methamphetamine abuse presented with left‐sided weakness and dysarthria, onset was 2 hours prior to arrival, his NIHSS was 11, CT head was negative for hemorrhage, CT angiogram of head and neck showed tandem occlusion of right ICA and right MCA bifurcation, he was in window for intravascular thrombolysis without contraindication, so he received Alteplase, he was brought into Angio‐suite for mechanical thrombectomy, On Right CCA injection there was complete occlusion of Right ICA with TICI‐0 flow, distal branches of Right ACA and MCA were not visualized. Mechanical thrombectomy was done on Right ICA and Right MCA. During clot retrieval, flow arrest was achieved by inflating the balloon guide with diluted contrast. Post thrombectomy there was extravasation around the right CCA and ICA, so the balloon guide was reinflated to have a florist around the catheter and hemostasis in the right ICA, two carotid stents were deployed sequentially with rapid exchange technique with overlapping technique, an endovascular graft was introduced and deployed at mid cervical segment at the point of leak and dissection. Post mechanical thrombectomy, TICI‐3 flow in the right ICA, and MCA were achieved, the patient was discharged to rehab in a stable condition on dual antiplatelet regimen. Conclusions CBS is a rare complication during mechanical thrombectomy, early and aggressive intervention in CBS is crucial to prevent devastating consequences, Transient balloon occlusion distal to the carotid blowout of the ICA is a reasonable technique for completing endovascular management with stenting.

Roadmapping technique in the hybrid operating room for the microsurgical treatment of complex intracranial aneurysms.

To describe the roadmapping technique and our three-year experience in the management of intracranial aneurysms in the hybrid operating room. We analyzed all patients who underwent surgical clipping for cerebral aneurysms with the roadmapping technique from January 2017 to September 2019. We report demographic, clinical, and morphological variables, as well as clinical and radiological outcomes. We further describe three illustrative cases of the technique. A total of 13 patients were included, 9 of which (69.2%) presented with subarachnoid hemorrhage, with a total of 23 treated aneurysms. All patients were female, with a mean age of 47.7 years (range 31-63). All cases were anterior circulation aneurysms, the most frequent location being the ophthalmic segment of the internal carotid artery (ICA) in 11 cases (48%), followed by posterior communicating in 8 (36%), and ICA bifurcation in 2 (8%). Intraoperative clip repositioning was required in 9 aneurysms (36%) as a result of the roadmapping technique in the hybrid operating room. There were no residual aneurysms in our series, nor reported mortality. The roadmapping technique in the hybrid operating room offers a complementary tool for the adequate occlusion of complex intracranial aneurysms, as it provides a real time fluoroscopic-guided clipping technique, and clip repositioning is possible in a single surgical stage, whenever a residual portion of the aneurysm is identified. This technique also provides some advantages, such as immediate vasospasm identification and treatment with intra-arterial vasodilators, balloon proximal control for certain paraclinoid aneurysms, and simultaneous endovascular treatment in selected cases during a single stage.

Ruptured giant fusiform aneurysm in an infant: Case report and review of the literature.

Background: Intracranial aneurysms are exceedingly rare in neonates, accounting for less than 2% of all relevant cases that occur during the first decade of life. More precisely, intracranial aneurysms in children (less than 18 years old) are rarely been recorded, and their epidemiology is poorly investigated. Details about this pathology in this specific population are lacking. Because of the scarcity of this entity along with the peculiar characteristics of this patient group, the treatment of aneurysms of the cerebral circulation of these patients is challenging. The prevalence of Intracranial aneurysms in children is much lower than in adults· apart from that, several differences exist, centered on their etiology, demographic variables, aneurysm location, aneurysm morphological characteristics, clinical presentation, and outcome in pediatric and adult intracranial aneurysms. We describe the case of aneurysmal subarachnoid hemorrhage and extra-axial hemorrhage in an infant, as well as the review of the relevant current literature. Case description: We report the case of a three months old infant who was admitted to our hospital due to episodes of vomiting, associated with loss of consciousness and an epileptic ictus. An MRI-MRA scan and a digital subtraction angiography were immediately performed, which revealed the presence of a giant fusiform aneurysm near the origin of the right anterior cerebral artery. Because of the location and shape of the aneurysmal sac, the ipsilateral internal carotid artery was totally occluded with detachable coils. At follow-up, the child experienced normal psychomotor development with no motor deficit. Conclusions: Intracranial aneurysms should be considered in the differential diagnosis of infants and neonates who present with acute raised intracranial pressure. Even though rupture of an intracranial aneurysm in this age group is rare, subarachnoid hemorrhage is the most common mode of presentation. Intracranial aneurysms are frequently larger than 10 mm and located on the middle cerebral artery. The treatment could be surgical or endovascular, depending on the characteristics of the aneurysm. Seizures and cranial nerve involvement are the most common presenting features in children. The most commonly encountered sites of origin for such aneurysms are the posterior circulation, along with the internal carotid artery bifurcation. Current literature and case series suggest that there is increased incidence of giant, posttraumatic, and mycotic aneurysms in children. Based on the most recently published data, the treatment of ruptured and unruptured pediatric aneurysms is related with an increased incidence of an uneventful outcome, which reaches 95% in the current series. Pediatric intracranial aneurysms are more commonly encountered in male patients and have a predilection for the terminal ICA bifurcation.

Hemichorea after internal carotid artery bifurcation aneurysm clipping

Abstract Involuntary movements following aneurysm surgery are rare. Here, we report the case of a patient who developed left hemichorea following surgical clipping of a right internal carotid artery bifurcation aneurysm. The movement disorder resulted from an acute infarct involving the head of the caudate nucleus. The patient responded well to symptomatic treatment, with complete resolution of chorea. The occurrence of new-onset involuntary movements following aneurysm surgery should raise the suspicion of infarcts involving basal ganglia structures.

Comparing treatment outcomes of various intracranial bifurcation aneurysms locations using the Woven EndoBridge (WEB) device

BackgroundThe Woven EndoBridge (WEB) device has Food and Drug Administration approval for treatment of wide-necked intracranial bifurcation aneurysms. The WEB device has been shown to result in adequate occlusion in...

Management of Complex Cerebral Aneurysms

Complex intracranial aneurysms (CIAs) are challenging pathologies to treat. Characteristics making an aneurysm complex include dimension, history of previous treatment, location, absence of collateral circulation, intraluminal thrombosis, and calcification of the wall. The goal of the therapeutic process is to exclude the malformation from the cerebral circulation and both endovascular and surgical treatments are valid procedures. Between 1990 and 2020, 170 CIAs were treated at our institution (33 ruptured, 137 unruptured). They were 3 prepetrous segment of the internal carotid artery (ICA), 14 purely intracavernous sinus, 27 intracavernous with subarachnoid extension, 60 paraclinoid, 4 ICA bifurcation, 15 anterior communicating artery, 24 middle cerebral artery, and 23 in the posterior circulation. All the patients underwent neuroradiologic examinations and images were evaluated by the neurosurgical and interventional radiologist team. Endovascular treatment was considered as the treatment of choice. Alternative treatment was surgical clipping; revascularization procedures were performed when neither endovascular treatment nor direct clipping were possible. Of 170 patients, 45 underwent endovascular treatment, 77 surgical clipping, and 55 revascularization procedures. In the unruptured group, 12 patients died, 22 reported major complications, 3 had minor complications, and 101 had an uneventful postoperative course. In the ruptured group, 9 patients died, 10 had minor complications, 1 minor complication, and 13 had a complete recovery. Endovascular treatment should represent the treatment of choice for CIAs. Alternative treatments include direct surgical clipping and revascularization. Overall, the correct identification of the therapeutic process guarantees a good clinical outcome.

Carotid Geometry and Wall Shear Stress Independently Predict Increased Wall Thickness-A Longitudinal 3D MRI Study in High-Risk Patients.

Introduction: Carotid geometry and wall shear stress (WSS) have been proposed as independent risk factors for the progression of carotid atherosclerosis, but this has not yet been demonstrated in larger longitudinal studies. Therefore, we investigated the impact of these biomarkers on carotid wall thickness in patients with high cardiovascular risk.Methods: Ninety-seven consecutive patients with hypertension, at least one additional cardiovascular risk factor and internal carotid artery (ICA) plaques (wall thickness ≥ 1.5 mm and degree of stenosis ≤ 50%) were prospectively included. They underwent high-resolution 3D multi-contrast and 4D flow MRI at 3 Tesla both at baseline and follow-up. Geometry (ICA/common carotid artery (CCA)-diameter ratio, bifurcation angle, tortuosity and wall thickness) and hemodynamics [WSS, oscillatory shear index (OSI)] of both carotid bifurcations were measured at baseline. Their predictive value for changes of wall thickness 12 months later was calculated using linear regression analysis for the entire study cohort (group 1, 97 patients) and after excluding patients with ICA stenosis ≥10% to rule out relevant inward remodeling (group 2, 61 patients).Results: In group 1, only tortuosity at baseline was independently associated with carotid wall thickness at follow-up (regression coefficient = −0.52, p < 0.001). However, after excluding patients with ICA stenosis ≥10% in group 2, both ICA/CCA-ratio (0.49, p < 0.001), bifurcation angle (0.04, p = 0.001), tortuosity (−0.30, p = 0.040), and WSS (−0.03, p = 0.010) at baseline were independently associated with changes of carotid wall thickness at follow-up.Conclusions: A large ICA bulb and bifurcation angle and low WSS seem to be independent risk factors for the progression of carotid atherosclerosis in the absence of ICA stenosis. By contrast, a high carotid tortuosity seems to be protective both in patients without and with ICA stenosis. These biomarkers may be helpful for the identification of patients who are at particular risk of wall thickness progression and who may benefit from intensified monitoring and treatment.