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108 Background: Correlative analysis of vascular  anatomy on CT angiography (CTA) with transcranial Doppler  ultrasonography (TCD) patterns of embolism may elucidate dynamic  embolic particle behavior in humans.Methods: CTA was  performed in 81 consecutive patients (median age 62 years, range 8–90;  54% female), employing Vitrea™ software to obtain 2D  multiplanar-reformatted and 3D volume-rendered images. Two independent  observers measured angulation and luminal diameters of the supraclinoid  carotid (ICA), and proximal anterior (ACA) and middle (MCA) cerebral  arteries. Based on previously described TCD methods, ipsilateral ACA  and MCA were monitored for emboli in 10 patients with extracranial ICA  stenosis (mostly solid emboli) and 8 with prosthetic cardiac valves  (mostly gaseous emboli).Results: Pathologic CTA findings at  the terminal ICA bifurcation were noted in 12% (20/162), with  hypoplastic A1 segments observed in 11% (16/142) of normal  bifurcations. Diameter of the A1 segment was significantly smaller than  the M1, mean 2.55 mm (95%CI ±.05) vs 3.19 mm (±.07), p&lt;.0001. A1  diameter contralateral to a diseased A1 was significantly larger, 2.70  mm (p=.05). ACA-ICA angulation was more acute than MCA-ICA, 81.13°  (±1.50) vs 134.87° (±1.10), p&lt;.0001. Angle relative to gravity was  greater for ACA than MCA in natural head posture (63.73° (±3.50) vs  30.59° (±14.00), p&lt;.0001) and supine TCD position (26.27°  (±3.50) vs -59.41° (±14.00), p&lt;.0001). ICA emboli exhibited a  greater tendency to enter the MCA than those from cardiac valves:  ACA/MCA emboli ratio of .32 (44/138) vs .54 (241/449), p&lt;.0001.Conclusions: Vascular anatomy and embolic particle  composition interact to determine embolus destination at the terminal  ICA bifurcation. Larger, heavier than plasma, solid emboli are  proportionately more likely to enter the MCA due to its wider diameter,  downward gravitational position, and lesser path angularity; smaller,  lighter than plasma, gaseous emboli are more likely to enter the ACA  due to its upward gravitational position, and their lesser  susceptibility to momentum and vessel diameter influences.

CT Angiography Reveals Anatomic Features that Account for the Distribution of Emboli in the Anterior Cerebral Circulation