{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T19:17:51Z","timestamp":1789154271365,"version":"build-2803163510"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2023,10,17]]},"abstract":"<jats:sec sec-type=\"background\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Adaptive arterial remodeling caused by flow reduction from downstream stenosis has been demonstrated in animal studies. The authors sought to determine whether inward remodeling from downstream stenosis also occurs in humans and is detectable by ex vacuo expansion of the Rektorzik venous plexus (RVP) surrounding the petrous internal carotid artery.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              The authors analyzed 214 intracranial magnetic resonance imaging examinations that included contrast\u2010enhanced vessel wall imaging. RVP symmetry was qualitatively assessed on vessel wall imaging. RVP thickness (RVPT) was measured on the thicker side if asymmetric or randomly assigned side if symmetric. Maximum stenosis (M1 or intracranial internal carotid artery) was measured. Posterior communicating artery and A1 diameters (&gt;1.0\u2009mm and 1.5\u2009mm, respectively) defined adequate collateral outflow when proximal to the stenosis. Seventy\u2010two patients had stenosis downstream from RVPT measurements. For those without adequate outflow (38 of 72), 95.0% with RVPT \u22651.0\u2009mm had \u226550% stenosis compared with only 5.6% with RVPT &lt;1.0\u2009mm. For these 72 patients, higher RVPT (RVPT \u22651.0\u2009mm versus &lt;1.0\u2009mm) and absent adequate outflow were associated with greater downstream stenosis (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001) using multivariate regression. For patients with downstream stenosis without adequate outflow, asymmetric RVP thickening was associated with greater ipsilateral stenosis (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.001, all had \u226546% stenosis) when stenosis was unilateral and greater differences in stenosis between sides (\n              <jats:italic>P<\/jats:italic>\n              =0.005) when stenosis was bilateral.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Inward internal carotid artery remodeling measured by RVPT or RVP asymmetry occurs as downstream stenosis approaches 50%, unless flow is preserved through a sufficiently sized posterior communicating artery or A1, and may serve as a functional measure of substantial flow reduction from downstream stenosis.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.123.031832","type":"journal-article","created":{"date-parts":[[2023,10,13]],"date-time":"2023-10-13T10:16:30Z","timestamp":1697192190000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["A Novel Window Into Human Vascular Remodeling and Diagnosing Carotid Flow Impairment: The Petro\u2010Occipital Venous Plexus"],"prefix":"10.1161","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1993-1860","authenticated-orcid":false,"given":"Wenjie","family":"Yang","sequence":"first","affiliation":[{"name":"Department of Diagnostic Radiology &amp; Nuclear Medicine University of Maryland School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1030-752X","authenticated-orcid":false,"given":"Kevin","family":"Sam","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology &amp; Nuclear Medicine University of Maryland School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0499-9283","authenticated-orcid":false,"given":"Ye","family":"Qiao","sequence":"additional","affiliation":[{"name":"Russell H. Morgan Department of Radiology and Radiological Sciences Johns Hopkins School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6623-5959","authenticated-orcid":false,"given":"Zhongqing","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology &amp; Nuclear Medicine University of Maryland School of Medicine Baltimore MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7963-1168","authenticated-orcid":false,"given":"David A.","family":"Steinman","sequence":"additional","affiliation":[{"name":"Department of Mechanical &amp; Industrial Engineering University of Toronto Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8458-1778","authenticated-orcid":false,"given":"Bruce A.","family":"Wasserman","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology &amp; Nuclear Medicine University of Maryland School of Medicine Baltimore MD"},{"name":"Russell H. 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