Evaluation of Hemodynamics and Plaque Morphology in Patients with Atherothrombotic Lesion of Extracranial Arteries

Abstract

Background: Atherothrombotic lesions of extracranial arteries, particularly the internal carotid arteries (ICA), are a major cause of ischemic stroke. While the degree of arterial stenosis is traditionally used for risk assessment, increasing evidence indicates that hemodynamic impairment and plaque morphology play a critical role in determining cerebrovascular risk.

Objective: To evaluate cerebral hemodynamics and atherosclerotic plaque morphology in patients with atherothrombotic lesions of extracranial arteries and to determine their diagnostic and prognostic significance in stroke risk stratification.

Materials and Methods: A total of 128 elderly patients with confirmed ICA stenosis were examined between 2022 and 2024. Patients were divided into three groups: unilateral ICA stenosis (n=41), bilateral ICA stenosis (n=58), and combined ICA and vertebral artery (VA) stenosis (n=29). Cerebrovascular reserve (CVR) was assessed using transcranial Doppler with vasoactive testing. Cerebral perfusion parameters (CBF, CBV, MTT, Tmax) were evaluated using CT and MR perfusion techniques. Plaque morphology was analyzed using high-resolution duplex ultrasonography and MRI according to established classifications. Statistical analysis was performed using SPSS, MedCalc, and R software.

Results: Progressive deterioration of cerebral hemodynamics was observed with increasing severity and extent of vascular lesions. CVR, CBF, and CBV were significantly reduced, while MTT and Tmax were prolonged, particularly in patients with combined ICA and VA stenosis (p<0.05). Morphological analysis revealed a significantly higher prevalence of unstable, ulcerative, and lipid-rich plaques in patients with bilateral and combined stenosis compared to unilateral lesions and controls (p<0.001). Calcified plaques showed no significant association with stenosis severity.

Conclusion: Atherothrombotic lesions of extracranial arteries are associated with marked hemodynamic impairment and progressive plaque destabilization. Comprehensive assessment combining hemodynamic parameters and plaque morphology provides superior risk stratification compared to stenosis degree alone and should be integrated into clinical decision-making for stroke prevention and treatment planning.