Supplementary Material for: Association of Carotid Artery Endothelial Signal Intensity Gradient with Unilateral Large Artery Ischemic Stroke

Background: Common carotid artery (CCA) and internal carotid artery (ICA) are aligned linearly, but their hemodynamic role in ischemic stroke has not been studied in depth. Objectives: We aimed to investigate whether CCA and ICA endothelial shear stress (ESS) could be associated with the ischemic stroke of large artery atherosclerosis (LAA). Methods: We enrolled consecutive patients with unilateral ischemic stroke of LAA and healthy controls aged >60 years in the stroke center of Jeonbuk National University Hospital. All patients and controls were examined with carotid artery time-of-flight magnetic resonance angiography, and their endothelial signal intensity gradients (SIGs) were determined, as a measure of ESS. The effect of right or left unilateral stroke on the association between carotid artery endothelial SIG and ischemic stroke of LAA was assessed. Results: In total, the results from 132 patients with ischemic stroke of LAA and 121 controls were analyzed. ICA endothelial SIG showed significant and independent associations with the same-sided unilateral ischemic stroke of LAA, even after adjusting for the potential confounders including carotid stenosis, whereas CCA endothelial SIG showed a significant association with the presence of the ischemic stroke of LAA. Conclusion: Although CCA and ICA are located with continuity, the hemodynamics and their roles in large artery ischemic stroke should be considered separately. Further studies are needed to delineate the pathophysiologic roles of ESS in CCA and ICA for large artery ischemic stroke.背景：颈总动脉（Common Carotid Artery, CCA）与颈内动脉（Internal Carotid Artery, ICA）呈线性走行排列，但二者在缺血性脑卒中中的血流动力学作用尚未得到深入研究。研究目的：本研究旨在探讨颈总动脉与颈内动脉的内皮剪切应力（Endothelial Shear Stress, ESS）是否与大动脉硬化性缺血性脑卒中（Large Artery Atherosclerosis, LAA）相关。研究方法：我们在全北国立大学医院卒中中心招募了年龄＞60岁的单侧大动脉硬化性缺血性脑卒中连续患者与健康对照者。所有受试者均接受颈动脉飞行时间磁共振血管成像（Time-of-Flight Magnetic Resonance Angiography, TOF-MRA）检查，并测定其内皮信号强度梯度（Signal Intensity Gradients, SIG）作为内皮剪切应力的评估指标。同时评估单侧脑卒中（左侧或右侧）对颈动脉内皮信号强度梯度与大动脉硬化性缺血性脑卒中之间关联的影响。研究结果：最终共纳入132例大动脉硬化性缺血性脑卒中患者与121例对照者的研究数据进行分析。在校正包括颈动脉狭窄在内的潜在混杂因素后，颈内动脉内皮信号强度梯度仍与同侧单侧大动脉硬化性缺血性脑卒中存在显著且独立的关联；而颈总动脉内皮信号强度梯度则与大动脉硬化性缺血性脑卒中的发生存在显著关联。研究结论：尽管颈总动脉与颈内动脉解剖结构连续，但二者的血流动力学特征及其在大血管源性缺血性脑卒中中的作用需分别考量。未来仍需开展进一步研究，以阐明内皮剪切应力在颈总动脉与颈内动脉中对大血管源性缺血性脑卒中的病理生理作用机制。