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Factors Associated with High-Risk Plaque Characteristics Among Patients with Medium to Severe Carotid Artery Stenosis
George Galyfos1, Georgios Charalampopoulos1, Georgios Karagiannis1
1Vascular Unit, First Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece.
Insights
This study identified risk factors for unstable carotid plaques, including C-reactive protein and low high-density lipoprotein levels. These findings may aid in developing prognostic models for early intervention in high-risk patients.
Area of Science:
- Vascular Medicine
- Cardiology
- Neurology
Background:
- Significant carotid artery stenosis management is debated, especially for asymptomatic patients.
- Identifying risk factors for high-risk carotid plaques is crucial for clinical decision-making.
Purpose of the Study:
- To identify potential risk factors associated with high-risk carotid plaques.
- To analyze associations between patient characteristics and plaque features.
Main Methods:
- Retrospective analysis of a prospective database of patients with moderate to severe carotid stenosis (≥50%).
- Inclusion in the multicenter TAXINOMISIS project (NCT03495830).
- Assessment using color Duplex ultrasound and magnetic resonance angiography, with plaque classification by Gray-Weale criteria (types I-V).
Main Results:
- C-reactive protein > 2 mg/l correlated with symptomatic stenosis (OR=9.92, P=0.039).
- Low high-density lipoprotein levels (<1200 mmol/l) associated with lipidic/necrotic plaque core (OR=16.88, P=0.043).
- Low high-density lipoprotein and HbA1c >7% linked to plaque types III/IV, while HbA1c >7% associated with type V plaques.
Conclusions:
- Preliminary findings suggest potential risk factors for unstable carotid plaques.
- These risk factors may contribute to future prognostic models for identifying patients needing intervention.
Background:
There has been a large discussion in literature regarding the proper management of asymptomatic patients with significant carotid artery stenosis. This study aims to identify potential risk factors associated with high-risk carotid plaques.
Methods:
This is a retrospective study based on a prospective database. Eligible patients had medium to severe symptomatic or asymptomatic carotid stenosis (≥50%, North American Symptomatic Carotid Endarterectomy Trial criteria). This study will analyze patients recruited by our institution as part of the multicenter TAXINOMISIS project (NCT03495830). According to protocol, all patients underwent a colored Duplex ultrasound examination and a magnetic resonance angiography at baseline. Carotid plaques were classified according to Gray-Weale ultrasonographic criteria (types I-V). Main outcomes included the occurrence of symptoms, the high/low echogenicity of the plaque, the existence of intraplaque hemorrhage and the existence of lipidic/necrotic core. Secondary, risk factors associated with the aforementioned outcomes were evaluated.
Results:
A total of 62 patients (mean age: 68.7 ± 9.3 years, 66.1% males, 24.2% symptomatic) were recruited by our department. Mean carotid stenosis was 70.81% ± 13.53%. In multivariate regression analysis, C-reactive protein > 2 mg/l was strongly associated with symptomatic stenosis (odds ratio [OR] = 9.92 [1.12-88.178]; P = 0.039), and low high-density lipoprotein levels (<1200 mmol/l) were associated with lipidic/necrotic plaque core (OR = 16.88 [1.10-259.30]; P = 0.043). Low high-density lipoprotein levels (OR = 7.22 [1.00-51.95], P = 0.049) and HbA1c >7% (OR = 0.08 [0.01-0.93], P = 0.044) were associated with type III/IV plaques whereas HgAbc1 >7% (OR = 14.26 [1.21-168.34], P = 0.035) was associated with type V plaques.
Conclusions:
This preliminary study has revealed some potential risk factors associated with unstable carotid plaques. These data could help the future development of prognostic models for early detection patients that could benefit from further intervention.
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