Investigating the Association Between Carotid Atherosclerotic Plaque Characteristics And Lacunar Infarction Using...

Increasing evidence links large artery atherosclerosis to cerebral small vessel disease(CSVD), but the relationship between carotid vulnerable plaque features and lacunar infarction (LAC) remains unclear. This study investigates this association in patients with moderate-to-severe carotid stenosis.

Patients with symptomatic 50-99% or asymptomatic 70-99% carotid stenosis referred for carotid endarterectomy were recruited. All underwent carotid vessel wall and brain MRI. Plaque burden and compositional characteristics were assessed. LAC presence was determined and severity categorized as mild (1-5), moderate (6-10), or severe (>10 infarcts). Logistic regression analyzed associations of plaque features with LAC presence and severity.

Among 194 patients (84% male, mean age 65.3±8.0 years), 110 (56.7%) had LAC. LAC patients had larger calcification volume (OR 1.004, 95%CI 1.000-1.007) and calcified area percentage (OR 1.052, 95%CI 1.017-1.089). Mild and moderate LAC also showed larger calcified area percentages (OR 1.060, 95%CI 1.019-1.102 and OR 1.061, 95%CI 1.012-1.113, respectively). Severe LAC patients had higher LRNC (OR 1.002, 95%CI 1.000-1.003) and IPH volumes (OR 1.003, 95%CI 1.001-1.006).

Our study demonstrates that LAC patients exhibit significantly greater carotid plaque calcification burden, particularly in mild-to-moderate cases, with these associations remaining statistically significant after multivariable adjustment. Severe LAC shows stronger correlations with IPH and LRNC volumes, suggesting that vulnerable plaque characteristics may mediate distinct pathophysiological mechanisms in patients with severe LAC.