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Multimodal Risk Stratification Clue of Carotid Bifurcation Plaques: A Cross-Sectional Observational Study of Vector

Liuming Shi1,2,3, Yijie Ning1,2, Qian Wang4

  • 1Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China.

Translational Stroke Research
|April 29, 2026
PubMed

Insights

Vector Flow (V-Flow) imaging reveals hemodynamic parameters like oscillatory shear index and time-averaged turbulence intensity are key indicators of symptomatic carotid atherosclerosis. Integrating these with Plaque-RADS and clinical data improves high-risk plaque prediction.

Area of Science:

  • Cardiovascular Imaging
  • Biomedical Engineering
  • Vascular Medicine

Background:

  • Carotid atherosclerosis poses a significant stroke risk.
  • Accurate risk stratification of carotid bifurcation plaques is crucial for patient management.
  • Current methods may not fully capture plaque instability dynamics.

Purpose of the Study:

  • To quantify hemodynamic parameters in carotid bifurcation plaques using Vector Flow (V-Flow) imaging.
  • To identify determinants of symptomatic status in carotid atherosclerosis.
  • To enhance risk stratification by integrating hemodynamic data, Plaque-RADS grading, and clinical factors.

Main Methods:

  • A cross-sectional study of 160 patients with carotid bifurcation plaques.
  • High-frame-rate V-Flow imaging to measure wall shear stress (WSS), oscillatory shear index (OSI), and time-averaged turbulence intensity (TATur).
  • Plaque-RADS grading and multivariable logistic regression to analyze associations with symptomatic status.

Main Results:

  • Symptomatic patients had higher prevalence of comorbidities and greater plaque length/thickness.
  • Increased OSI and TATur in middle segments, and higher WSSmax/WSSmean, OSI, and TATur in distal segments were observed in symptomatic patients.
  • Triglycerides, plaque length, TATur-Mid, WSSmax-Distal, and Plaque-RADS were independent predictors of symptomatic status.

Conclusions:

  • V-Flow derived hemodynamic metrics (OSI, TATur) are strongly associated with symptomatic carotid disease.
  • A combined model including V-Flow, Plaque-RADS, and clinical factors significantly improves prediction of high-risk plaques.
  • These integrated parameters enhance individualized risk stratification for carotid atherosclerosis.

Keywords:
Carotid plaquesHemodynamicsHigh-frame-rate Vector Flow (V-Flow) imagingIschemic strokePlaque-RADSRisk assessment

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