(Stroke. 2001;32:1525.)
© 2001 American Heart Association, Inc.
Original Contributions |
Sex Differences in Carotid Bifurcation Anatomy and the Distribution of Atherosclerotic Plaque
From the Stroke Prevention Research Unit, Department of Clinical Neurology, Radcliffe Infirmary, Oxford, England.
Background and Purpose—Plaque formation at arterial bifurcations depends on vessel anatomy, particularly the relative sizes of the branches, and the ratio of the outflow to inflow area. The facts that carotid plaque is more common in men and that carotid bruits in the absence of stenosis are more frequent in women raise the possibility that there are sex differences in carotid bifurcation anatomy. We studied 5395 angiograms from the European Carotid Surgery Trial.
Methods—To minimize
secondary changes we excluded angiograms with 
50% stenosis
and also studied vessels with no disease. We measured
arterial diameters at disease-free points and calculated
the following ratios: internal/common (ICA/CCA); external/common
(ECA/CCA); internal/external (ICA/ECA) carotid arteries; carotid
bulb/CCA; and outflow/inflow area. We related these to sex and also
studied the distribution of plaque in the whole trial
population.
Results—Among 2930 angiograms with <50% stenosis, the mean ICA/CCA ratio, ICA/ECA ratio, and outflow/inflow area ratio were larger in women than in men (all P<0.0001). The findings were similar in 622 bifurcations without atheroma. There were also differences in the distribution of plaque, with men more likely to have the maximum stenosis distal to the carotid bulb (odds ratio, 2.29; 95% CI, 1.33 to 4.01; P=0.001) and women more likely to have stenosis of the ECA (odds ratio, 1.54; 95% CI, 1.30 to 1.85; P<0.0001).
Conclusions—Sex differences in carotid bifurcation anatomy are not limited to absolute vessel size. In addition, the outflow to inflow area ratio is bigger in women, and relative to the CCA and ECA, women have larger ICAs than men. Irrespective of whether these differences are congenital or acquired, they may partly explain the sex differences that we found in the distribution of plaque and the sex differences in the prevalence of carotid atheroma in the general population.
Key Words: anatomy • angiography • carotid arteries • gender
This article has been cited by other articles:
 |
|
 |
|
  D. J. Gladstone, J. Oh, J. Fang, P. Lindsay, J. V. Tu, F. L. Silver, and M. K. Kapral Urgency of Carotid Endarterectomy for Secondary Stroke Prevention: Results From the Registry of the Canadian Stroke Network Stroke, August 1, 2009; 40(8): 2776 - 2782. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Klein, R. A. Hegele, D. G. Hackam, M. L. Koschinsky, M. W. Huff, and J. D. Spence Lipoprotein(a) Is Associated Differentially With Carotid Stenosis, Occlusion, and Total Plaque Area Arterioscler Thromb Vasc Biol, October 1, 2008; 28(10): 1851 - 1856. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Sander, C. Schulze Horn, C. Briesenick, and D. Sander High-Sensitivity C-Reactive Protein Is Independently Associated With Early Carotid Artery Progression in Women But Not in Men: The INVADE Study Stroke, November 1, 2007; 38(11): 2881 - 2886. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Krejza, M. Arkuszewski, S. E. Kasner, J. Weigele, A. Ustymowicz, R. W. Hurst, B. L. Cucchiara, and S. R. Messe Carotid Artery Diameter in Men and Women and the Relation to Body and Neck Size Stroke, April 1, 2006; 37(4): 1103 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. E. Kasner, M. I. Chimowitz, M. J. Lynn, H. Howlett-Smith, B. J. Stern, V. S. Hertzberg, M. R. Frankel, S. R. Levine, S. Chaturvedi, C. G. Benesch, et al. Predictors of Ischemic Stroke in the Territory of a Symptomatic Intracranial Arterial Stenosis Circulation, January 31, 2006; 113(4): 555 - 563. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. B. Thomas, L. Antiga, S. L. Che, J. S. Milner, D. A. Hangan Steinman, J. D. Spence, B. K. Rutt, and D. A. Steinman Variation in the Carotid Bifurcation Geometry of Young Versus Older Adults: Implications for Geometric Risk of Atherosclerosis Stroke, November 1, 2005; 36(11): 2450 - 2456. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dick, C. Sherif, S. Sabeti, J. Amighi, E. Minar, and M. Schillinger Gender Differences in Outcome of Conservatively Treated Patients With Asymptomatic High Grade Carotid Stenosis Stroke, June 1, 2005; 36(6): 1178 - 1183. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. I. Levin The Puzzle of Aspirin and Sex N. Engl. J. Med., March 31, 2005; 352(13): 1366 - 1368. [Full Text] [PDF]
|
|
|
|
|
|
S. Alamowitch, M. Eliasziw, H. J.M. Barnett, and for the North American Symptomatic Carotid Endarte The Risk and Benefit of Endarterectomy in Women With Symptomatic Internal Carotid Artery Disease Stroke, January 1, 2005; 36(1): 27 - 31. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S R Messe, S E Kasner, Z Mehta, C P Warlow, P M Rothwell, and for the European Carotid Surgery Trialists Effect of body size on operative risk of carotid endarterectomy J. Neurol. Neurosurg. Psychiatry, December 1, 2004; 75(12): 1759 - 1761. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Iemolo, A. Martiniuk, D. A. Steinman, and J. D. Spence Sex Differences in Carotid Plaque and Stenosis Stroke, February 1, 2004; 35(2): 477 - 481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rothwell For Severe Carotid Stenosis Found on Ultrasound, Further Arterial Evaluation Prior to Carotid Endarterectomy Is Unnecessary: The Argument Against Stroke, July 1, 2003; 34(7): 1817 - 1819. [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rothwell, S. A. Gutnikov, and C. P. Warlow Reanalysis of the Final Results of the European Carotid Surgery Trial Stroke, February 1, 2003; 34(2): 514 - 523. [Abstract] [Full Text] [PDF]
|
|