Carotid vulnerable plaque coexisting with cerebral small vessel disease and acute ischemic stroke: a Chinese
Jin Li1,2, Hengqu Wu3, Hailun Hang4
1Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Insights
Carotid vulnerable plaque features combined with cerebral small vessel diseases (CSVDs), especially lacunes, significantly increase acute ischemic stroke (AIS) risk. This combination shows a stronger association with AIS than either condition alone in symptomatic patients.
Area of Science:
- Neurology
- Cardiology
- Radiology
Background:
- Cerebral small vessel diseases (CSVDs) and carotid vulnerable plaques are independent risk factors for acute ischemic stroke (AIS).
- The combined impact of these coexisting conditions on AIS risk requires further investigation.
Purpose of the Study:
- To investigate the association between carotid vulnerable plaque features coexisting with CSVDs and AIS.
- To determine if coexisting diseases have a stronger association with AIS than single diseases.
Main Methods:
- Recruited 634 patients with cerebrovascular symptoms and carotid plaque from the multicenter CARE-II study.
- Evaluated MRI features of carotid plaques and CSVDs (white matter hyperintensities, lacunes).
- Used multivariate logistic regression to analyze associations between coexisting diseases and AIS.
Main Results:
- Patients with AIS showed a higher prevalence of carotid vulnerable plaques, lacunes, and moderate-to-severe white matter hyperintensities compared to TIA patients.
- Carotid plaque features coexisting with lacunes or moderate-to-severe white matter hyperintensities were more strongly associated with AIS than carotid lesions alone.
- The adjusted odds ratio for vulnerable plaque coexisting with lacunes was 3.67, versus 1.62 for vulnerable plaque alone.
Conclusions:
- Carotid vulnerable plaque features coexisting with CSVDs, particularly lacunes, demonstrate a stronger association with AIS in symptomatic individuals.
- Comprehensive assessment of coexisting cerebrovascular diseases can aid in stratifying AIS risk.
Objectives:
We aimed to investigate the associations between carotid vulnerable plaque features coexisting with cerebral small vessel diseases (CSVDs) and acute ischemic stroke (AIS) and, furthermore, to determine whether coexisting diseases had a stronger association with AIS than a single disease.
Methods:
Patients with cerebrovascular symptoms and carotid plaque were recruited from the cross-sectional, multicenter CARE-II study. The population was divided into two groups (AIS and transient ischemic stroke (TIA)). MRI features of carotid plaques (including luminal stenosis and plaque vulnerabilities) and CSVDs (such as white matter hyperintensities (WMHs) and lacunes) were evaluated. Coexisting diseases were defined as the presence of at least one carotid plaque features and one or more CSVDs feature. Multivariate logistic regression was performed to examine the associations between coexisting diseases and AIS.
Results:
Of the recruited 634 patients (mean age: 59.1 ± 11.3 years; 429 males), 312 (49.2%) patients had AIS. These subjects had a higher prevalence of carotid vulnerable plaques, lacunes, and moderate-to-severe WMHs (a total Fazekas score of 3-6) than those with TIA (42.6% vs. 29.5%, 59.6% vs. 26.4%, 69.9% vs. 60.6%, respectively, all p < 0.05). Multivariate analysis revealed that carotid plaque features coexisting with lacunes or moderate-to-severe WMHs had a stronger association with AIS compared to carotid lesions alone (all p < 0.05) (i.e., vulnerable plaque coexisting with lacunes vs. vulnerable plaque alone, adjusted odds ratio: 3.67 vs. 1.62).
Conclusions:
Carotid vulnerable plaque features coexisting with CSVDs, particularly lacunes, had a stronger association with AIS compared to carotid lesions alone in a large, symptomatic, cohort.
Trial Registration:
Clinical trial registration URL: http://www.
Clinicaltrials:
gov , unique identifier: NCT02017756 KEY POINTS: • Carotid vulnerable plaque features coexisting with cerebral small vessel diseases, such as lacunes, had a stronger association with acute ischemic stroke compared to single diseases in symptomatic patients. • A comprehensive assessment of coexisting cerebrovascular diseases may help stratify the risk of acute ischemic stroke.
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