Prognostic value of plaque burden on computed tomography angiography in patients with symptomatic carotid artery
Kelly P H Nies1,2, Jente C L Willems1,2, Dianne H K van Dam-Nolen3,4
1Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
Insights
Carotid plaque burden on CT angiography (CTA) independently predicts recurrent stroke in symptomatic stenosis patients. This finding suggests CTA offers valuable predictive insights when MRI is not feasible.
Area of Science:
- Neurology
- Vascular Medicine
- Medical Imaging
Background:
- Symptomatic carotid stenosis increases stroke risk.
- Plaque burden on MRI predicts stroke, but CT is preferred in acute settings.
- CTA's predictive value for stroke risk in carotid stenosis is under investigation.
Purpose of the Study:
- To determine if carotid plaque burden on CTA independently predicts recurrent ipsilateral ischemic events.
- To assess if CTA plaque burden adds predictive value to existing stroke risk models.
Main Methods:
- The Plaque At RISK (PARISK) study included symptomatic patients with <70% carotid stenosis.
- Carotid plaque burden was quantified using semiautomated segmentation on baseline CTA.
- Cox proportional hazards models assessed the association between plaque burden and recurrent ipsilateral ischemic events.
Main Results:
- A larger plaque burden on CTA was associated with an increased risk of recurrent ipsilateral stroke or TIA (HR=1.07 per 100 μL increase; P=.04).
- Adding plaque burden to the ECST score improved its predictive performance (C-statistic increased from 0.65 to 0.70).
- 26 out of 199 patients experienced a recurrent ipsilateral event during a median follow-up of 5.1 years.
Conclusions:
- CTA-derived carotid plaque burden is an independent predictor of recurrent stroke or TIA in symptomatic patients with <70% stenosis.
- CTA provides valuable predictive information for stroke risk, comparable to MRI findings.
- CTA is a practical tool for assessing stroke risk in patients where MRI is not readily available.
Introduction:
Patients with symptomatic carotid stenosis are at increased risk for recurrent ischaemic stroke. Plaque burden on MRI has been shown to independently predict (recurrent) ischaemic stroke. However, CT is usually preferred in acute stroke patients due to its availability and rapid scan time. We examined whether carotid plaque burden on CTA can also independently predict (recurrent) ipsilateral ischaemic cerebrovascular symptoms in patients with symptomatic carotid stenosis.
Patients And Methods:
In the Plaque At RISK (PARISK) study, recently symptomatic patients with < 70% carotid stenosis underwent a carotid CTA at baseline. Plaque burden was quantified as total plaque volume (μL) of the ipsilateral carotid artery using semiautomated segmentation. Cox proportional hazards models were used to assess whether plaque burden on CTA was associated with recurrent ipsilateral ischaemic events. Plaque burden was added to an existing prediction model (ECST score) to determine additional predictive value.
Results:
During a median follow-up of 5.1 [IQR: 3.4-5.7] years, 26 of 199 patients experienced a (recurrent) ipsilateral TIA or stroke. A larger plaque burden increased the risk of recurrent ipsilateral stroke or TIA (HR = 1.07 [95% CI, 1.00-1.14] per 100 μL increase; P = .04). Performance of the ECST score increased from a C-statistic of 0.65-0.70 upon addition of plaque burden.
Discussion:
The association between CTA-based plaque burden and recurrent ischaemic events aligns with previous MRI-based findings, suggesting that CTA can provide predictive value when MRI is unavailable.
Conclusions:
Plaque burden on CTA is an independent predictor for recurrent ipsilateral stroke or TIA in symptomatic patients with a < 70% carotid stenosis.
More Related Videos
04:40Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
![Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT](/_next/image?url=https%3A%2F%2Fcloudfront.jove.com%2FCDNSource%2Fteasers%2F3777.jpg&w=3840&q=50)
10:02Quantification of Atherosclerotic Plaque Activity and Vascular Inflammation using [18-F] Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography FDG-PET/CT
Published on: May 2, 2012
Related Concept Videos
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:30Atherosclerosis I: Introduction
01:28Imaging Studies for Cardiovascular System V: CT
01:30Coronary Artery Disease I: Introduction
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies