Background: Atherosclerosis of the internal carotid artery (ICA) are an important cause of ischemic stroke. Artery-to-artery embolism is the major stroke mechanism in patients with atherosclerotic carotid disease. We hypothesized that the atherosclerotic ICA geometry and plaque location would be associated with the lesion pattern in acute ischemic stroke.
Methods: Ischemic stroke patients with symptomatic proximal ICA disease (> 50% diameter stenosis) were enrolled. The carotid plaque location was divided into high-apical and low-body types. The geometric parameters of the ICA (angles between arteries) were measured; moreover, ischemic lesion patterns were classified according to the number, location, and size of the lesions. Factors associated with plaque location and lesion pattern (dichotomized by size) were investigated.
Results: A total of 93 patients (31 high-apical plaques and 62 low-body plaques) were investigated. In patients with low-body plaques, hyperlipidemia was more prevalent and the common carotid artery (CCA)-ICA angle was wider (162.3 ± 9.8° vs. 167.7 ± 10.4°, p = 0.019). Low-body plaques more frequently appeared as small scattered or cortical lesions (54.8% vs. 32.3%, p = 0.040), whereas high-apical plaques more frequently appeared as a large lesion with additional lesions (38.7% vs. 11.3%, p = 0.002). Low-body plaques (odds ratio 3.106, 95% confidence interval 1.105–8.728, p = 0.032) was independently associated with the small lesions only pattern.
Conclusions: Low-body plaques more frequently present small-scattered lesions, whereas high-apical plaques more frequently present a large lesion with additional lesions. A wide CCA-ICA angle is associated with low-body plaque of the carotid artery.