Optimal Carotid Plaque Features on Computed Tomography Angiography Associated With Ischemic Stroke

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Carotid stenosis has been the primary determinant for identifying carotid stroke sources.
• Emerging evidence indicates that specific carotid plaque features on imaging may be more strongly linked to ischemic stroke than stenosis alone.

Purpose of the Study:

• To identify computed tomography angiography (CTA) imaging features of carotid plaque that effectively differentiate ipsilateral stroke sources.
• To compare the discriminatory power of CTA plaque features against traditional stenosis measurements for stroke prediction.

Main Methods:

• Retrospective cross-sectional study of 494 carotid CTA-brain MRI pairs.
• Multivariable Poisson regression and backward elimination were used to develop a prediction model.
• Receiver operating characteristic analysis and area under the curve (AUC) were employed to assess discriminatory value.

Main Results:

• The final CTA model included intraluminal thrombus, maximum soft plaque thickness, and the rim sign, achieving an AUC of 78.3%.
• This model demonstrated superior stroke discrimination compared to individual plaque features (AUCs 56.4%–76.4%) and NASCET stenosis categories (AUC 67.4%).

Conclusions:

• Optimal identification of ipsilateral carotid stroke sources necessitates evaluating intraluminal thrombus, maximum soft plaque thickness, and the rim sign.
• These findings challenge the sole reliance on carotid stenosis for stroke source determination via CTA, advocating for these alternative markers to diagnose vulnerable plaque and inform treatment.