Assessment of carotid plaques stability and its correlation with ischemic stroke through computed tomography angiography

OBJECTIVE: To investigate the relationship between carotid plaque stability characteristics and ischemic stroke risk using computed tomography angiography (CTA), with a focus on differences between embolic stroke of undetermined source (ESUS) and non-ESUS cases. METHODS: This retrospective study included 173 patients with carotid plaques who underwent extracranial carotid CTA. Patients were categorized into stroke and non-stroke groups, with the stroke group further divided into ESUS and non-ESUS subgroups. Plaque features including stenosis severity, plaque type, ulceration, intraplaque hemorrhage (IPH), and lipid-rich necrotic core (LRNC) were assessed. Clinical information was also collected to examine the connection between carotid plaque characteristics and stroke risk. RESULTS: Compared to the non-stroke group, the stroke group had a higher proportion of male patients, elevated total cholesterol levels, greater stenosis severity, along with higher frequencies of plaque ulceration, calcification, IPH, and LRNC. Also, the maximum soft and total plaque thickness were greater, while maximum hard plaque thickness was lower. Multivariate logistic regression identified male gender, stenosis severity, LRNC, and maximum soft plaque thickness as independent risk factors. Among stroke patients, the ESUS group exhibited a higher prevalence of non-stenotic plaques (stenosis <50%), along with significantly increased IPH, plaque calcification, and adventitial calcification, compared to the non-ESUS group. CONCLUSION: CTA-based assessment of carotid plaque features enables effective evaluation of stroke risk. Notably, vulnerable plaques with non-severe stenosis may contribute to the pathogenesis of ESUS, underscoring the need for plaque composition analysis beyond luminal narrowing.