Hemodynamic evaluation of endarterectomy and stenting treatments for carotid web

Abstract

Background and purposeA carotid web is a thin, shelf-like luminal protrusion in the internal carotid artery that might cause carotid stenosis and stroke by inducing disturbed flow patterns, thrombosis, and abnormal biomechanical stimulus to the endothelial cells. This study simulated and evaluated how the two main treatments (endarterectomy and stenting) influence hemodynamic environments in the carotid artery and distal carotid siphon arteries, aiming to provide more references for the selection of clinical treatment.Materials and methodsThe carotid web, endarterectomy, and stenting models were reconstructed based on CT images. The blood flow simulations were conducted, and critical parameters related to thrombosis formation and artery remodeling, including swirling strength, wall shear stress (WSS), vortex Q-criterion, and oscillating shear index (OSI), were analyzed.ResultsIn the model of the carotid web, obvious recirculation formed distal to the web, accompanied by lower velocity, lower WSS, higher relative resident time (RRT), and higher Q value. While in both two treatment models, the velocity increased and the Q value and RRT decreased at the carotid bifurcation. In addition, both treatments provide more kinetic energy to the distal carotid siphon artery, especially the stenting model.ConclusionThe carotid web can significantly influence the flow environments in the carotid artery. Both endarterectomy and stenting treatments could significantly diminish the side effects of the web and are feasible choices for web patients in terms of hemodynamics. Besides, the treatments for the carotid web would also influence the flow patterns at the distal carotid siphon, especially for the stenting treatment. But more innovational designs are needed to make the minimally invasive stenting treatment more beneficial.

Carotid web: a case report

“…El carotid web es una protuberancia intimal de prevalencia incierta con predominio en las mujeres que se localiza frecuentemente en la cara posterolateral proximal de la carótida interna y asocia accidentes isquémicos transitorios e ictus embólicos en pacientes jóvenes sin factores de riesgo cardiovasculares clásicos (1). Esto se produce por la afectación hemodinámica del flujo distal al septo (2). El diagnóstico se realiza mediante angiografía por TC o por resonancia magnética (3).…”

The carotid web: Current research status and imaging features

“…Surgical procedures for the carotid web mainly include carotid endarterectomy and artery stenting, both of which have satisfactory outcomes ( Joux et al, 2014 ; Lenck et al, 2014 ; Choi et al, 2015 ; Haussen et al, 2018 ; Marnat et al, 2022 ; Patel et al, 2022 ; Ren et al, 2022 ). Research has revealed that, during follow-up, surgically treated carotid web patients reported that they did not experience recurrent strokes ( Joux et al, 2014 ; Choi et al, 2015 ).…”