The effect of carotid artery geometric measurements and degree of stenosis on infarct volume and in- hospital mortality in patients with middle cerebral artery infarction

Abstract

Background & Objective: Atherosclerosis of the internal carotid artery (ICA) is a major cause of middle cerebral artery (MCA) infarction. This study aimed to investigate the relationship between carotid artery angles and diameters and infarct volume, and to determine the impact of these measurements on in-hospital mortality in patients with MCA infarction.

Methods: This retrospective observational cohort study included patients with symptomatic ICA stenosis of 50–95% and no other identifiable etiology who had suffered an MCA infarction. From computed tomography angiography images, we measured the common carotid artery (CCA)–ICA angle, the carotid bifurcation angle, and the diameters of the carotid arteries. Infarct volumes were obtained from diffusion-weighted MRI. Statistical analyses included the independent two-sample t-test, Mann–Whitney U test, Spearman’s rho correlation, logistic regression, and receiver operating characteristic (ROC) analysis.

Results: A total of 79 patients (46 survivors, 33 non-survivors) were analyzed. Non-survivors had significantly larger infarct volumes (p<0.001). They also exhibited narrower CCA–ICA angles (p=0.001) and wider bifurcation angles (p<0.001). Infarct volume showed a weak but significant correlation with both bifurcation angle (r=0.327, p=0.003) and degree of ICA stenosis (r=0.371, p=0.001). Each 1° increase in bifurcation angle was associated with a 1.433-fold rise in mortality risk (p=0.013). The bifurcation angle had a strong predictive value for mortality (AUC=0.896).

Conclusions: In patients with MCA infarction, a wider carotid bifurcation angle and a narrower CCA– ICA angle are associated with in-hospital mortality. A 1° increase in the bifurcation angle increases the risk of in-hospital mortality by 1.433 times.