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Original research
Prolonged cerebral circulation time is more associated with symptomatic carotid stenosis than stenosis degree or collateral circulation
  1. Yong-Sin Hu1,2,
  2. Wan-Yuo Guo1,2,
  3. I-Hui Lee3,4,
  4. Feng-Chi Chang1,2,
  5. Chung-Jung Lin1,2,
  6. Chun-Jen Lin3,4,
  7. Chao-Bao Luo1,2,
  8. Chih-Chun Wu1,2,
  9. Han-Jui Lee1,2
  1. 1 Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
  2. 2 School of Medicine, National Yang-Ming University, Taipei, Taiwan
  3. 3 Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan
  4. 4 Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan
  1. Correspondence to Dr Chung-Jung Lin, Department of Radiology, Taipei Veterans General Hospital, No 201, Sec 2, Shipai Rd, Beitou District, Taipei 112, Taiwan; bcjlin{at}


Background and purpose Current practice of revascularization for carotid stenosis (CS) primarily relies on symptoms and degree of stenosis. Other parameters, such as collateral circulation and cerebral circulation time (CCT), might influence the stroke risk in CS. This study was conducted to (1) investigate whether CCT is more associated with symptomatic CS than degree of stenosis and (2) elucidate the associations among the degree of stenosis, collateral status, and CCT.

Methods From 2010 to 2016, 82 patients with unilateral CS were enrolled for DSA and divided into symptomatic and asymptomatic groups based on clinical presentation. CCT was defined as the difference between the time taken by the cavernous internal carotid artery and parietal vein to reach the maximal contrast medium intensities on lateral DSA. The degree of stenosis, collateral status, and CCT of the two groups were compared. Logistic regression analysis was performed to estimate the OR for symptomatic CS with the imaging variables.

Results The symptomatic group had a significantly higher degree of stenosis and longer CCT. CCT (OR 1.95, p=0.013) was more associated with symptomatic CS than the degree of stenosis (OR 1.03, p=0.229), after adjustment for potential confounders—namely, age, sex, antithrombotic use, and collateral status. Symptomatic high grade CS with collaterals had a non-significantly shorter CCT than those without collaterals.

Conclusions DSA derived CCT is more reflective of the hemodynamic differences between symptomatic and asymptomatic CS than degree of stenosis. Collaterals may not effectively reduce CCT in symptomatic high grade CS.

  • angiography
  • stenosis
  • artery
  • stroke

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  • Y-SH and W-YG contributed equally.

  • Contributors Conception and design: Y-SH, W-YG, and C-JL (Chung-Jung Lin). Acquisition of the data, analysis and interpretation of the data, and critically revising the article: all authors. Drafting the article: Y-SH and W-YG. Reviewed submitted version of manuscript: Y-SH, W-YG and C-JL (Chung-Jung Lin). Approved the final version of the manuscript on behalf of all authors: C-JL (Chung-Jung Lin). Administrative/technical/material support: all authors. Study supervision: C-JL (Chung-Jung Lin).

  • Funding This work was supported by the Taipei Veterans General Hospital (grant No V106-C-058) and Siemens Healthcare (grant No T1100200).

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the institutional review board of Taipei Veterans General Hospital.

  • Provenance and peer review Not commissioned; externally peer reviewed.