CT-assessment of carotid plaque features and their impact on residual stenosis after stenting

It is well established that calcified plaques are highly likely to lead to residual stenosis after stenting; however, the specific characteristics responsible for this effect remain unknown. This study aimed to identify both qualitative and quantitative imaging risk factors for residual stenosis using computed tomography angiography.

We retrospectively enrolled 233 patients with carotid artery stenosis. Patients were categorized into two groups based on the presence or absence of postoperative residual stenosis. Carotid computed tomography angiography evaluated plaque characteristics both qualitatively and quantitatively. Logistic regression analysis identified independent risk factors for residual stenosis. We evaluated the predictive model's discriminative ability by calculating the area under the receiver operating characteristic (ROC) curve.

Univariate analysis indicated a statistical difference in age, creatinine, total plaque volume, percentage of total calcified plaque, percentage of total soft plaque, maximum slice attenuation value, maximum thickness, total length, and a circumferential calcification score ≥2 points (p < 0.05). Multivariable logistic regression identified creatinine (OR = 1. 020; 95%CI: 1.005-1.035; p = 0.010), maximum slice attenuation value(Z-score; OR = 1.627; 95%CI: 1.024-2.585; p = 0.039), percentage of calcified plaque volume(Z-score; OR = 1.872; 95%CI: 1.137-3.082; p = 0.014) and circumferential calcification score ≥2 (OR = 3.257; 95%CI: 1.620-6.548; p < 0.001) as independent factors associated with residual stenosis. Furthermore, receiver operating characteristic curve analysis revealed that the area under the curve for the combined model in diagnosing residual stenosis was 0.784.

In conclusion, preoperative CTA-based assessment of specific plaque characteristics, such as calcified plaque volume percentage, circumferential calcium score, and the maximum slice attenuation value of calcification are related to residual stenosis.