{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T11:14:31Z","timestamp":1790421271906,"version":"4.1.0"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","funder":[{"name":"HHS | NIH | National Institute of Neurological Disorders and Stroke","award":["R01NS097876"],"award-info":[{"award-number":["R01NS097876"]}]},{"name":"HHS | NIH | National Institute of Neurological Disorders and Stroke","award":["U01NS080168"],"award-info":[{"award-number":["U01NS080168"]}]},{"name":"HHS | NIH | National Institute of Neurological Disorders and Stroke","award":["U01NS080165"],"award-info":[{"award-number":["U01NS080165"]}]},{"name":"HHS | NIH | National Institute of Neurological Disorders and Stroke","award":["NS086872"],"award-info":[{"award-number":["NS086872"]}]},{"name":"Regeneron Pharmaceuticals"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Cerebral hemodynamic impairment in patients with asymptomatic high-grade (&gt;70%) internal carotid artery (ICA) stenosis is associated with risk of stroke and cognitive decline, but correlations between the degree of stenosis and hemodynamic impairment are derived from small case series. Using baseline data from 242 participants in the CREST-H study (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis\u2013Hemodynamics), we hypothesized that the degree of stenosis in the ICA would correlate with time-to-peak (TTP) delay in ipsilateral cerebral blood flow using MR\/CT perfusion scans, adjusting for demographic and cardiovascular risk variables.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>From all participants, ICAs were insonated using a 7 to 10 MHz probe for peak systolic velocity (PSV) and end diastolic velocity. Dynamic contrast perfusion imaging was standardized across 61 CREST-H sites, using standard sequential T2*-weighted perfusion imaging. CT perfusion used standard clinical protocols. TTP delay was calculated in the ipsilateral versus contralateral hemispheres. In cross-sectional analysis, linear regression was used to model TTP delay as the outcome variable and PSV, end diastolic velocity, and PSV ICA\/common carotid artery ratio on the index and nonindex side as primary predictor variables in 6 separate models, adjusting for covariates, followed by automated backward elimination model reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Among 392 CREST-H participants, the 242 with complete data for all variables were included in the regression analysis (age, 70\u00b17.6; 62% M). End diastolic velocity on the index side correlated with TTP delay (\u03b2=0.003,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.005). PSV had a similar correlation but did not reach significance (\u03b2=0.001,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.099), nor did ICA\/common carotid artery ratio (\u03b2=0.003,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.126). Nonindex side PSV, end diastolic velocity, and ICA\/common carotid artery ratio showed no correlation with TTP delay (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.268,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.495,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.380, respectively). Circle of Willis completeness did not correlate with TTP.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In this large cohort of patients with high-grade asymptomatic carotid stenosis, higher end-diastolic flow velocities correlated with greater TTP delays, supporting a definition of hemodynamically significant stenosis. Our findings have implications for the management of asymptomatic carotid stenosis, which will be tested in the CREST-H study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT03121209.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.125.054149","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T10:01:19Z","timestamp":1769680879000},"page":"992-999","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Relationship Between Degree of Stenosis and Time-to-Peak Delay in High Grade Asymptomatic Carotid Artery Disease"],"prefix":"10.1161","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3037-0283","authenticated-orcid":true,"given":"Randolph S.","family":"Marshall","sequence":"first","affiliation":[{"name":"Department of Neurology, Columbia University Irving Medical Center, New York, NY (R.S.M., S.J., K.J.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6724-8201","authenticated-orcid":true,"given":"Brajesh K.","family":"Lal","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Maryland School of Medicine, Baltimore (B.K.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7788-4575","authenticated-orcid":true,"given":"Lloyd J.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (L.J.E., G.H.), University of Alabama at Birmingham."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0584-9460","authenticated-orcid":true,"given":"John","family":"Huston","sequence":"additional","affiliation":[{"name":"Department of Radiology (J.H., P.R.), Mayo Clinic, Rochester, MN."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4475-8142","authenticated-orcid":true,"given":"James F.","family":"Meschia","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1266-0941","authenticated-orcid":true,"given":"Thomas G.","family":"Brott","sequence":"additional","affiliation":[{"name":"Department of Neurology, Mayo Clinic, Jacksonville, FL (J.F.M., T.G.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3068-5720","authenticated-orcid":true,"given":"George","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (L.J.E., G.H.), University of Alabama at Birmingham."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4954-5672","authenticated-orcid":true,"given":"Carlos","family":"Mena-Hurtado","sequence":"additional","affiliation":[{"name":"Department of Medicine (Cardiology), Yale School of Medicine, New Haven, CT (C.M.-H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Heck","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Novant Health 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