Carotid intraplaque neovascularization for predicting ischemic cerebrovascular events in patients with hypertension
Ying Mi1, Luosa Yang1, Xiuli Jin1
1Department of Ultrasound Diagnosis, Chengde Central Hospital, Chengde, China.
Insights
Intraplaque neovascularization (IPN) in carotid plaques is linked to a higher risk of ischemic cerebrovascular events (ICEs) in hypertensive patients over 60. This finding suggests IPN grading can help identify high-risk individuals for stroke prevention.
Area of Science:
- Vascular biology and neuroscience
- Cardiology and cerebrovascular disease research
- Medical imaging and diagnostics
Background:
- Hypertension significantly increases the risk of developing carotid atherosclerotic plaques.
- Unstable carotid plaques are a primary cause of ischemic cerebrovascular events (ICEs), such as TIAs and strokes.
- Intraplaque neovascularization (IPN) within plaques is a key indicator of vulnerability.
Purpose of the Study:
- To investigate the association between intraplaque neovascularization (IPN) in carotid arteries and the risk of ischemic cerebrovascular events (ICEs).
- To evaluate IPN as a potential marker for cerebrovascular risk stratification in hypertensive older adults.
Main Methods:
- A retrospective cohort study involving 438 hypertensive patients aged 60 years and older.
- Carotid plaques were assessed using superb microvascular imaging (SMI) to grade IPN from 0 (none) to 3 (severe).
- Patients were followed for 3 years to monitor ICE incidence, with logistic regression analysis performed.
Main Results:
- Of 314 patients with plaques, 113 (36.0%) experienced ICEs.
- ICE incidence increased with IPN severity (15.2% for grade 0 to 51.2% for grade 3).
- Higher IPN grades (2 and 3) were significantly associated with increased odds of ICEs, and IPN remained an independent predictor after adjustments.
Conclusions:
- Carotid intraplaque neovascularization (IPN), detected by SMI, is independently linked to a higher risk of ICEs in hypertensive older adults.
- IPN grading shows promise as a valuable, noninvasive tool for assessing cerebrovascular risk in this patient group.
Background:
Patients with hypertension are prone to developing carotid atherosclerotic plaques, and unstable plaques are a key contributor to ischemic cerebrovascular events (ICEs), including transient ischemic attacks (TIAs) and ischemic strokes. Intraplaque neovascularization (IPN), the formation of microvessels within plaques, is a recognized marker of plaque vulnerability. This study aimed to evaluate the association between IPN in carotid plaques and the risk of ICEs in older adult patients with hypertension.
Methods:
This retrospective cohort study included 438 patients with hypertension aged ≥60 years. Carotid plaques were assessed with superb microvascular imaging (SMI), and IPN was graded from 0 (none) to 3 (severe). Patients were followed up for 3 years to track the incidence of ICEs. Logistic regression models were used to analyze the association between IPN grade and ICE risk, with adjustments made for demographic and cardiovascular risk factors.
Results:
Among the 314 patients with carotid plaques, 113 (36.0%) experienced ICEs during follow-up. The incidence of ICEs increased progressively with IPN severity: 15.2% for grade 0, 37.3% for grade 1, 50.5% for grade 2, and 51.2% for grade 3. Compared to that in patients with IPN grade 0, the odds of ICEs were significantly higher in patients with IPN grade 2 [odds ratio (OR) =3.73; P<0.01] and grade 3 (OR =5.14; P<0.01). IPN grade >1 was significantly associated with increased ICE risk (P<0.05). After adjustments were made for age, sex, smoking, diabetes, and hyperlipidemia, IPN remained an independent predictor of ICEs [adjusted OR =1.87; 95% confidence interval (CI): 1.12-3.14; P=0.03].
Conclusions:
Carotid IPN, as assessed by SMI, is independently associated with an elevated risk of ICEs in older adult patients with hypertension. IPN grading may serve as a useful and noninvasive marker for cerebrovascular risk stratification in this population.
