A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus
Background Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-10-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.031832 |
| _version_ | 1797301689056755712 |
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| author | Wenjie Yang Kevin Sam Ye Qiao Zhongqing Huang David A. Steinman Bruce A. Wasserman |
| author_facet | Wenjie Yang Kevin Sam Ye Qiao Zhongqing Huang David A. Steinman Bruce A. Wasserman |
| author_sort | Wenjie Yang |
| collection | DOAJ |
| description | Background Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery. Methods and Results The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast‐enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (>1.0 mm and 1.5 mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy‐two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT ≥1.0 mm had ≥50% stenosis compared with only 5.6% with RVPT <1.0 mm. For these 72 patients, higher RVPT (RVPT ≥1.0 mm versus <1.0 mm) and absent adequate outflow were associated with greater downstream stenosis (P<0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (P<0.001, all had ≥46% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (P=0.005) when stenosis was bilateral. Conclusions Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis. |
| first_indexed | 2024-03-07T23:26:12Z |
| format | Article |
| id | doaj.art-e2c6858c70c8456489ba30f17057f347 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-03-07T23:26:12Z |
| publishDate | 2023-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-e2c6858c70c8456489ba30f17057f3472024-02-21T04:31:11ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-10-01122010.1161/JAHA.123.031832A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous PlexusWenjie Yang0Kevin Sam1Ye Qiao2Zhongqing Huang3David A. Steinman4Bruce A. Wasserman5Department of Diagnostic Radiology & Nuclear Medicine University of Maryland School of Medicine Baltimore MDDepartment of Diagnostic Radiology & Nuclear Medicine University of Maryland School of Medicine Baltimore MDRussell H. Morgan Department of Radiology and Radiological Sciences Johns Hopkins School of Medicine Baltimore MDDepartment of Diagnostic Radiology & Nuclear Medicine University of Maryland School of Medicine Baltimore MDDepartment of Mechanical & Industrial Engineering University of Toronto CanadaDepartment of Diagnostic Radiology & Nuclear Medicine University of Maryland School of Medicine Baltimore MDBackground Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery. Methods and Results The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast‐enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (>1.0 mm and 1.5 mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy‐two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT ≥1.0 mm had ≥50% stenosis compared with only 5.6% with RVPT <1.0 mm. For these 72 patients, higher RVPT (RVPT ≥1.0 mm versus <1.0 mm) and absent adequate outflow were associated with greater downstream stenosis (P<0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (P<0.001, all had ≥46% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (P=0.005) when stenosis was bilateral. Conclusions Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis.https://www.ahajournals.org/doi/10.1161/JAHA.123.031832black blood MRIintracranial stenosisRektorzik venous plexusvascular remodelingvessel wall imaging |
| spellingShingle | Wenjie Yang Kevin Sam Ye Qiao Zhongqing Huang David A. Steinman Bruce A. Wasserman A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease black blood MRI intracranial stenosis Rektorzik venous plexus vascular remodeling vessel wall imaging |
| title | A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus |
| title_full | A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus |
| title_fullStr | A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus |
| title_full_unstemmed | A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus |
| title_short | A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro‐Occipital Venous Plexus |
| title_sort | novel window into human vascular remodeling and diagnosing carotid flow impairment the petro occipital venous plexus |
| topic | black blood MRI intracranial stenosis Rektorzik venous plexus vascular remodeling vessel wall imaging |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.031832 |
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