Identification of High Risk Carotid Artery Stenosis: A Multimodal Vascular and Perfusion Imaging Study
Moo-Seok Park1, Soonwook Kwon1, Mi Ji Lee1
1Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Insights
Identifying key imaging markers for symptomatic carotid artery stenosis (SCAS) is crucial for risk stratification. Multimodal imaging revealed that absence of plaque calcification, deep white matter hyperintensity, susceptibility vessel sign, and increased cerebral blood volume are associated with SCAS.
Area of Science:
- Neurology
- Radiology
- Vascular Surgery
Background:
- Risk stratification of asymptomatic carotid artery stenosis (ACAS) remains a challenge for carotid revascularization decisions.
- Identifying factors associated with symptomatic carotid artery stenosis (SCAS) is critical for patient management.
Purpose of the Study:
- To identify multimodal imaging factors associated with symptomatic carotid artery stenosis (SCAS).
- To improve risk stratification for patients with carotid artery stenosis.
Main Methods:
- Retrospective analysis of 259 patients undergoing carotid revascularization.
- Comparison of imaging results (duplex sonography, CTA, MRI, MRA, PWI) and demographics between ACAS and SCAS groups.
- Propensity score matching and multivariable regression analysis to identify independent predictors of symptomaticity.
Main Results:
- Absence of plaque calcification, deep white matter hyperintensity (DWMH), susceptibility vessel sign on MRI, and increased cerebral blood volume (CBV) on PWI were independently associated with SCAS.
- The combination of these imaging markers showed fair accuracy in classifying SCAS (AUC 0.733).
Conclusions:
- Multimodal imaging identifies key markers independently associated with symptomatic carotid artery stenosis.
- These markers may help identify asymptomatic patients at high risk for ischemic stroke.
- Further validation in independent cohorts is warranted to predict SCAS using these findings.
Abstract:
Background: Risk stratification of asymptomatic carotid artery stenosis (ACAS) is still an issue for carotid revascularization. We sought to identify factors associated with symptomatic carotid artery stenosis (SCAS) using multimodal imaging techniques. Methods: We retrospectively collected data on patients who underwent carotid artery revascularization. Results from duplex sonography, computerized tomography angiography, brain magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), perfusion-weighted imaging, and demographic profiles were compared between ACAS and SCAS patients. Differences in baseline characteristics between the two groups were balanced by the propensity matching score method. Multivariable regression analysis was performed to identify factors associated with symptomaticity of carotid artery stenosis. We compared the strength of associations between significant imaging factors and symptomatic carotid stenosis using C statistics. Results: A total of 259 patients (asymptomatic 57.1%, symptomatic 42.9%) with carotid stenosis were included. After 1:1 propensity score matching, the multivariable regression analysis revealed that the absence of plaque calcification [Odds ratio 0.41, 95% confidence interval (CI) 0.182-0.870, p = 0.023], deep white matter hyperintensity (DWMH; Odds ratio 3.46, 95% CI 1.842-6.682, p < 0.001), susceptibility vessel sign seen on gradient-echo MRI (Odds ratio 2.35, 95% CI 1.113-5.107, p = 0.027), and increased cerebral blood volume (CBV) seen on perfusion-weighted MRI (CBV; Odds ratio 2.17, 95% CI 1.075-4.454, p = 0.032) were associated with SCAS. The combination of these variables had a fair accuracy to classify SCAS (Area under the curve 0.733, 95% CI 0.662-0.803). Conclusions: We identified several multimodal imaging markers independently associated with SCAS. These markers may provide information to identify ACAS patients with high risk of ischemic stroke. Future studies are needed to predict SCAS using our findings in other independent cohorts.
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