Stenoses, Carotid, Stroke
Conditions
Keywords
computed tomography, carotid, atherosclerotic, plaque, density, stroke
Brief summary
Ischaemic stroke is attributable to thromboembolism caused by carotid atherosclerotic disease in 18-25% of patients. Guidelines for prevention of stroke (especially carotid endarterectomy) in patients with carotid atherosclerotic plaque are based on the quantification of the degree of stenosis. The hyoid bone, in proximity to the carotid artery, has been implicated in the pathophysiology of carotid artery dissection, atherosclerotic carotid disease, and compressive syndromes. In atherosclerotic carotid disease, pressure on the carotid artery induced by these bone structures has been proposed to play a possible role in plaque formation and rupture, leading to stenosis, occlusion, or artery-to-artery embolism. In a recent ultrasound study, dynamic displacement of the carotid artery with interference of the hyoid bone during swallowing, named as flip-flop phenomenon (FFP) has been associated with carotid artery stenosis and stenosis-related stroke. Another study based on CTA assessment observed no association between hyoid-carotid distance and plaque thickness, stenosis, or progression of thickness/stenosis. In that study, in almost two-third of the patients CTA was performed for stroke/transient ischemic attack work-up, including a vast majority of patients with absence of carotid stenosis (median degree of carotid stenosis was 7%), and plaque-related stroke was not assessed. The objective of this study is to determine the anatomic hyoid-carotid interaction (ie, hyoid-carotid distance, carotid position relative to the hyoid bone, and hyoid morphology) based on CTA and its relation to the degree of carotid stenosis and stenosis-related stroke.
Interventions
None, pure observational study
Sponsors
Centre Hospitalier Universitaire de Nīmes
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients followed at the University Hospital of Nîmes between November 2016 and March 2020 * Age \> 18 years * Patients who underwent carotid endarterectomy for symptomatic or asymptomatic stenosis
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Distance hyoid-carotid artery | Base line, Day 0 | the closest distance between the hyoid bone and the outer vessel wall of the carotid artery(mm) |
| Carotid artery portion closest to the hyoid bone | Base line, Day 0 | Depending on the level of the carotid bifurcation: common carotid artery \[CCA\], carotid bifurcation \[CB\], or internal carotid artery \[ICA\]) |
| Carotid artery position in regard to ipsilateral greater horn of the hyoid | Base line, Day 0 | The position of the carotid artery in regard to the ipsilateral greater horn of the hyoid (expressed in angle degree, with 0 to 90° corresponding to the posterolateral carotid position, 90 to 180° to anterolateral, 0 to -90° to posteromedial position, and -90 to-180° to anteromedial carotid position) |
| Hyoid bone morphology | base line, day 0 | Hyoid width (HW), hyoid length (HL), and hyoid circumferential length (HCL) |
Countries
France
Outcome results
None listed