Carotid plaque CTA analysis in patients with initial and recurrent ischemic stroke

OBJECTIVES: Recurrent ischemic stroke leads to prolonged hospital stays, deterioration in functional outcomes, increased disability and mortality rates. The composition of plaques is closely related to the occurrence of stroke. Our aim was to explore differences in carotid plaque characteristics between patients with initial and recurrent ischemic stroke. METHODS: A retrospective study was conducted on 208 anterior circulation stroke patients who had completed head and neck CT angiography (CTA) examinations. Patients were divided into initial cerebral infarction (ICI) group and recurrent cerebral infarction (RCI) group according to clinical and imaging data. The histological and morphological characteristics of the plaques were assessed by using VascuCAP software. The general demographic data, plaque characteristics, and serological indicators were compared between the two groups. Then, the association between plaque characteristics were investigated. To investigate the contribution of plaque characteristics for predicting the risk of stroke recurrence, we have constructed multivariate logistic regression models with plaque characteristics and blood lipid level parameters. RESULTS: There were significant differences in total carotid plaque volume (P = 0.002) between the ICI and RCI groups. The volume and percentage of Intraplaque Hemorrhage (IPH) and calcification (CALC) in the RCI group were significantly higher than those in the ICI group (P < 0.05). There were also statistically significant differences in IPH volume (P=＜0.001)and IPH percentage (P＜0.001)between the symptomatic and asymptomatic sides in the RCI group. In the ICI group, the difference in the maximum stenosis of the carotid artery lumen was statistically significant between the 2 sides (P = 0.025). The total cholesterol (P = 0.024) and triglyceride levels (P = 0.049) was significantly larger in the ICI group than in the RCI group. Further, there is a significant negative correlation between the volumes and percentages of IPH and CALC in the ICI group (volume, r = -0.225, P = 0.021; percentage, r = -0.293, P = 0.002). In addition, IPH volume and percentage were independent predictors in the logistic model with combined features of plaque volume, plaque percentage and blood lipid level (AUC = 0.755, 95 %CI 0.690-0.820). CONCLUSION: The volume of total carotid plaque and IPH were significantly different between the ICI group and RCI group. The IPH volume and percentage on the symptomatic side of the RCI group were higher than those on the asymptomatic side. IPH has important indicative significance in identifying patients at risk of recurrent stroke. ABBREVIATIONS: CTA, computed tomography angiography; ICI, initial cerebral infarction; RCI, recurrent cerebral infarction; IPH, intraplaque hemorrhage; CALC, calcification; AUC, area under the curve; CI, confidence interval.