Quantitative Magnetic Resonance Imaging and Computational Analysis of Hemodynamics for Evaluating Internal Carotid Artery Stenosis

Motivation: Assessment of internal carotid artery (ICA) stenosis is based on %stenosis which does not account for plaque vulnerability (PV) or hemodynamics. Goal(s): We used qMatch and MRI-informed computational fluid dynamics (CFD) to assess differences in PV and hemodynamics in patients with severe ICA stenosis. Approach: Patients with asymptomatic >70% ICA stenosis were prospectively enrolled for MRI. CFD models informed by phase-contrast-MRI and time-of-flight-MRI/CTA were used to measure hemodynamics. PV was assessed via qMatch-MRI. Results: 23 patients were included(8 surgery). Hemodynamics did not differ between surgery and non-surgery patients. Twelve patients had qMatch data and 3(25%) had PV. 12 non-surgery patients had concerning hemodynamics/PV. Impact: This work highlights how percentage ICA stenosis does not account for physiological-relevant risks for stroke. We found a subset of patients not selected for surgery that may be at high risk of stroke. These data support larger follow-up prospective studies.