Cerebrovascular events: correlation with plaque type, velocity parameters and multiple risk factors

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Updated: Jun 5, 2026

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

A Magnetic Resonance Imaging-based Computational Protocol for Analysis of Plaque Morphology and Hemodynamics in Patients with Carotid Artery Stenosis

Published on: August 12, 2025

Mirza Dilic¹, Mehmed Kulic, Sefkija Balic

¹Clinic of Vascular Disease, Clinical Centre University of Sarajevo, Bosnia and Herzegovina. mdilic@bih.net.ba

Medicinski Arhiv

|January 21, 2011

Insights

Heterogeneous plaques in carotid arteries are linked to cerebrovascular events (CVE), particularly transient ischemic attacks (TIAs) and ischemic stroke (IS). Specific Doppler ultrasound parameters like peak-systolic velocity (PSV) and end-diastolic velocity (EDV) correlate with CVE risk.

Area of Science:

Vascular Medicine
Neurology
Medical Imaging

Background:

Cerebrovascular events (CVE) are a leading cause of death, with atherosclerosis in carotid arteries being a primary cause.
Color Doppler ultrasound is crucial for assessing carotid artery plaque morphology and hemodynamic parameters.

Purpose of the Study:

To correlate morphological and velocity parameters from carotid Doppler ultrasound with clinical variables in patients who have experienced CVE.
To identify ultrasound markers predictive of different types of cerebrovascular events.

Main Methods:

A study involving 211 patients with CVE (TIAs, recurrent TIAs, ischemic stroke, recurrent ischemic stroke) and 50 controls.
Evaluation of plaque composition, echogenicity, peak-systolic velocity (PSV), and end-diastolic velocity (EDV).
Assessment of multiple risk factors (MRF) including hypertension, smoking, hyperlipidemia, obesity, and diabetes.

Main Results:

Heterogeneous plaques were significantly associated with TIAs and recurrent ischemic stroke (rIS).
Increased PSV was observed in TIAs and recurrent TIAs compared to controls.
Low EDV (<16 cm/s) was a significant predictor of ischemic stroke (IS) and rIS.

Conclusions:

Heterogeneous carotid plaques are prevalent in patients with TIAs and rIS.
Elevated PSV is linked to TIAs and rTIAs, while low EDV predicts IS and rIS.
Multiple risk factors are elevated in CVE patients, but differences between CVE subgroups were not significant.

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Abstract

Purpose:

Cerebrovascular events (CVE) are the third most common cause of death in Western countries and about 65-70% of CVE are due to atherosclerotic disease of carotid arteries. Color Doppler scanning is used to evaluate the presence, severity and type of atheromatous plaques as well as velocity parameters of carotid arteries. We performed this study to correlate data of morphological and velocity parameters with clinical variables in patients following CVE.

Methods:

We included total of 211 pts who had CVE, 118 females, 93 males, mean age 71.1 +/- SD 12.5 years. Out of total number of pts (n = 211) 93 pts had transient ischemic attacks (TIAs), 49 had recurrent TIAs (rTIAs), 44 had ischemic stroke (IS), and 25 had recurrent IS (rIS). As a control group we took 50 pts without CVE but with at least three multiple risk factor (MRF). Morphological parameters were; plaque composition and echogenecity. Velocity parameters were: peak-systolic velocity (PSV) and end-diastolic velocity (EDV). The following MRF were evaluated: age, gender, hypertension, tobacco smoking, hyperlipidemia (total cholesterol and LDL-cholesterol), obesity, and diabetes mellitus. Examination was performed on CCA/ICA segment.

Results:

We found significant presence of heterogeneous plaques in TIAs and rIS subgroup, p < 0.014, and borderline significance for the rTIAs and IS subgroups, p < 0.04. We found significant difference in PSV in TIAs and rTIAs subgroups vs. controls (PSV 103 cm/s vs. PSV in controls 87 cm/s, p < 0.01). Decreased EDV, below 20 cm/s, was found in all subgroups, p < 0.01, while EDV, below 16 cm/s, was found in IS and rIS subgroups. MRF score of CVE group was 4.34 vs. 3.65 in controls, p < 0.012, while MRF score in TIAs and rTIAs vs. IS and rIS subgroups was 4.34 vs. 4.51, NS, p = 0.14. We found a significant correlation (95% CI) of tobacco smoking, obesity and arterial hypertension with presence of heterogeneous plaques, p = 0.0069. Interestingly, hyperlipidemia showed no correlation with heterogeneous plaques, p = 0.027.

Conclusions:

(i) in CVE group we found significant presence of heterogeneous plaques in TIAs and rIS subgroups, (ii) in the pts with TIAs and rTIAs events we found significant increase in PSV, (iii) EDV below 16 cm/sec was a significant single predictor of IS and rIS events, (iv) MRF score was significantly increase in the pts with CVE compared to controls, but between CVE subgroups there was no significant difference.

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