Carotid Calcification Shape, Size, and Lumen Proximity Are Associated with Ischemic Events

While calcification is a highly prevalent component in atherosclerotic extracranial carotid arteries and is known to impact plaque stability, the link between carotid calcification and ischemic events is yet to be identified. We aimed to investigate the associations of geometric features of carotid calcifications, and their temporal changes, with ischemic events.

We retrospectively analyzed 128 mildly stenotic carotid arteries (Plaque At Risk study) from 64 patients with recent ischemic event, using multi-detector computed tomography angiography data at baseline and after 2 years. The 3D artery and calcification geometries were reconstructed with a semi-automatic pipeline, and an in-depth calcification morphometric assessment was performed. We examined the distribution of the calcification morphometrics and their temporal changes and investigated their associations with ischemic events at the time of inclusion, using generalized linear mixed models.

At baseline, compared to contralateral asymptomatic arteries, symptomatic carotids had more calcification bodies (mean [95%CI]: 1.9 [1.4-2.6] vs. 1.6 [1.2-2.2]). These calcifications were smaller (mean area [95%CI]: 3.7 mm² [2.9-5.1] vs. 4.5 mm² [3.5-5.8]) and narrower (mean width [95%CI]: 2.7 mm [2.3-3.4] vs. 3.1 mm [2.5-3.6]). At 2-year follow-up, adjusting for baseline measurements, these calcifications were smaller (mean width [95%CI]: 2.9 mm [2.5-3.5] vs. 3.3 mm [2.7-3.7]) and longer (mean [95%CI]: 8.6 mm [7.1-10.5] vs. 7.5 mm [6.3-9.5]) compared to asymptomatic side.

Symptomatic carotid arteries presented more and smaller calcifications with a tendency to grow more in the longitudinal artery direction, providing insights into the role of carotid calcifications in ischemic events.