Cortical Thinning in High-Grade Asymptomatic Carotid Stenosis

Randolph S. Marshall, David S. Liebeskind, John Huston, Lloyd J. Edwards, George Howard, James F. Meschia, Thomas G. Brott, Brajesh K. Lal, Donald Heck, Giuseppe Lanzino, Navdeep Sangha, Vikram S. Kashyap, Clarissa D. Morales, Dejania Cotton-Samuel, Andres M. Rivera, Adam M. Brickman, Ronald M. Lazar

Research output: Contribution to journalArticlepeer-review


Background and Purpose High-grade carotid artery stenosis may alter hemodynamics in the ipsilateral hemisphere, but consequences of this effect are poorly understood. Cortical thinning is associated with cognitive impairment in dementia, head trauma, demyelination, and stroke. We hypothesized that hemodynamic impairment, as represented by a relative time-to-peak (TTP) delay on MRI in the hemisphere ipsilateral to the stenosis, would be associated with relative cortical thinning in that hemisphere. Methods We used baseline MRI data from the NINDS-funded Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis–Hemodynamics (CREST-H) study. Dynamic contrast susceptibility MR perfusion-weighted images were post-processed with quantitative perfusion maps using deconvolution of tissue and arterial signals. The protocol derived a hemispheric TTP delay, calculated by subtraction of voxel values in the hemisphere ipsilateral minus those contralateral to the stenosis. Results Among 110 consecutive patients enrolled in CREST-H to date, 45 (41%) had TTP delay of at least 0.5 seconds and 9 (8.3%) subjects had TTP delay of at least 2.0 seconds, the maximum delay measured. For every 0.25-second increase in TTP delay above 0.5 seconds, there was a 0.006-mm (6 micron) increase in cortical thickness asymmetry. Across the range of hemodynamic impairment, TTP delay independently predicted relative cortical thinning on the side of stenosis, adjusting for age, sex, hypertension, hemisphere, smoking history, low-density lipoprotein cholesterol, and preexisting infarction (P=0.032). Conclusions Our findings suggest that hemodynamic impairment from high-grade asymptomatic carotid stenosis may structurally alter the cortex supplied by the stenotic carotid artery.

Original languageEnglish (US)
Pages (from-to)92-100
Number of pages9
JournalJournal of Stroke
Issue number1
StatePublished - Jan 2023


  • Brain cortical thickness
  • Carotid stenosis
  • Cerebral blood flow
  • Cognition
  • Perfusion weighted MRI

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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