Improved Geometric Variables for Predicting Disturbed Flow at the Normal Carotid Bifurcation

摘要

Recent work from our group has shown the primacy of the bifurcation area ratio and tortuosity in determining the amount of disturbed flow at the carotid bifurcation, believed to be a local risk factor for the carotid atherosclerosis. We have also presented fast and reliable methods of extraction of geometry from routine 3D contrast-enhanced magnetic resonance angiography, as the necessary step along the way for large-scale trials of such local risk factors. In the present study, we refine our original geometric variables to better reflect the underlying fluid mechanical principles. Flaring of the bifurcation, leading to flow separation, is defined by the maximum relative expansion of the common carotid artery (CCA), proximal to the bifurcation apex. The beneficial effect of curvature on flow inertia, via its suppression of flow separation, is now characterized by the tortuosity of CCA as it enters the flare region. Based on data from 50 normal carotid bifurcations, multiple linear regressions of these new independent geometric predictors against the dependent disturbed flow burden reveals adjusted R2 values approaching 0.5, better than the values closer to 0.3 achieved using the original variables. The excellent scan-rescan reproducibility demonstrated for our earlier geometric variables is shown to be preserved for the new definitions. Improved prediction of disturbed flow by robust and reproducible vascular geometry offers a practical pathway to large-scale studies of local risk factors in atherosclerosis.