Differences in left and right carotid plaque vulnerability in patients with bilateral carotid plaques: a CARE-II study

Associations of subclinical microcalcification and inflammation with carotid atheroma development: a dual-tracer PET/CT study

PURPOSE

Carotid artery atherosclerosis, a significant manifestation of cardiovascular disease (CVD) and leading cause of stroke, develops through a gradual process of arterial inflammation and calcification. This study explores the relationship between arterial inflammation (18 F-FDG PET/CT) and vascular calcification (18 F-NaF PET/CT) in the left and right common carotid arteries (LCC/RCC) and their association with CVD and thromboembolic risk in patients with subclinical atherosclerosis.

METHODS

A cohort of 115 subjects (73 healthy volunteers, 42 at-risk for CVD) underwent 18 F-NaF and 18 F-FDG PET/CT imaging. Radiotracer uptake was quantitatively assessed by measuring the average blood-pool-corrected mean standardized uptake value (aSUVmean).

RESULTS

Relative to healthy volunteers, at-risk subjects had greater uptake of NaF and FDG (10-22% and 16-27% higher, respectively, in both arteries, p < 0.05). On multivariate regression, NaF aSUVmean correlated with age and BMI (p < 0.01), and FDG aSUVmean correlated with BMI (p ≤ 0.01), fibrinogen (p < 0.01 in LCC only), and total cholesterol (p = 0.02 in RCC only). NaF aSUVmean increased with elevated 10-year CVD risk (p = 0.003 in LCC only), while no significant trend was seen for FDG. NaF and FDG aSUVmean increased with elevated thromboembolic risk in both arteries (p < 0.05). No correlations between NaF and FDG aSUVmean were observed (p > 0.05).

CONCLUSION

18 F-NaF PET/CT may serve as a prognostic tool for carotid microcalcification and subclinical atherosclerosis, while the utility of 18 F-FDG PET/CT remains uncertain.

CLINICAL TRIAL REGISTRATION

"Cardiovascular Molecular Calcification Assessed by 18F-NaF PET CT (CAMONA)", NCT01724749, https://clinicaltrials.gov/study/NCT01724749 .

Relationship Between Carotid Artery Remodeling Characteristics and Early Carotid Atherosclerosis: An Ultrasonographic Multicenter Study

OBJECTIVES

This study analyzed carotid artery remodeling characteristics in early carotid atherosclerosis (ECAS).

METHODS

The 1021 participants were evaluated using ultrasonography and categorized into three groups: Group A, 391 participants with increased intima-media thickness (IMT); Group B, 300 participants with atherosclerotic plaque only on the carotid bulb (CB); and the control group (330 participants). The ratios of the diameters in the CB to those in the common carotid artery (DCCA) and internal carotid artery (DICA) were defined as carotid index1 (CI1) and 2 (CI2).

RESULTS

Group A had a higher DCCA, DCB, and CI2 than the controls (P < .05). Group B had a smaller DCB, CI1, and CI2 than Group A, and higher DCCA and smaller CI1 than the controls (P < .05). Logistic regression showed that CI2 was a positive influencing factor for increased IMT (OR: 3.42, 95% CI: 1.74-6.70, P < .001), and CI1 was a negative independent factor for CB plaque formation (OR: 0.11, 95% CI: 0.04-0.28, P < .001). Multiple linear regression showed that only in Group B, the vessel side had a significant influence on CI1 (β = 0.055, P < .05), while age, sex, body mass index, and cerebrovascular risk factors had no significant correlation with CI.

CONCLUSIONS

The CB and common carotid artery showed positive remodeling with increased IMT, however, the CB showed negative remodeling with plaque formation. CI changes were consistent with CB remodeling. CI was an independent influencing factor for ECAS, and it was only affected by vessel side, providing an objective predictive parameter for ECAS.

Impact of Carotid Artery Geometry and Clinical Risk Factors on Carotid Atherosclerotic Plaque Prevalence

Objectives: Carotid geometry and cardiovascular risk factors play a significant role in the development of carotid atherosclerotic plaques. This study aimed to investigate the correlation between carotid plaque formation and carotid artery geometry characteristics. Methods: A retrospective cross-sectional analysis was performed on 1227 patients, categorized into a normal group (n = 685) and carotid plaque groups causing either mild stenosis (<50% stenosis based on NASCET criteria, n = 385) or moderate-to-severe stenosis (>50%, n = 232). The left and right carotid were evaluated individually for each group. Patient data, including cardiovascular risk factors and laboratory test results, were collected. Carotid geometric measurements were obtained from 3D models reconstructed from cranio-cervical computed tomography angiography (CTA) using semi-automated software (MIMICS). The geometric variables analyzed included the vascular diameter and sectional area of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid artery bifurcation (CAB), as well as the carotid bifurcation angles and carotid tortuosity. Results: Compared to the normal group, in both the right and left carotid arteries, patients with carotid plaques exhibited a significantly higher age (p < 0.001) and a greater prevalence of hypertension (p < 0.001) and diabetes mellitus (p < 0.001). Additionally, they demonstrated a larger CCA and a smaller carotid bifurcation dimension (p < 0.05). In the analysis of the left carotid artery, patients with carotid plaques also had a significantly smaller ICA dimension (p < 0.05) than the normal group. Conclusions: This study found that patients with carotid plaques were older and had a higher prevalence of hypertension and diabetes, larger CCAs, and smaller carotid bifurcations. The plaque-positive left ICA was significantly smaller than that of the plaque-negative group, suggesting a side-specific vulnerability. These findings highlight the role of carotid geometry in plaque formation and its potential clinical implications for personalized risk assessment and targeted interventions.

Development and Validation of a Fusion Model Based on Carotid Plaques and White Matter Lesion Burden Imaging Characteristics to Evaluate Ischemic Stroke Severity in Symptomatic Patients

BACKGROUND

The diagnostic value of carotid plaque characteristics based on higher-resolution vessel wall MRI (HRVW-MRI) combined with white matter lesion (WML) burden for the risk of ischemic stroke is unclear.

PURPOSE

To combine carotid plaque features and WML burden to construct a hybrid model for evaluating ischemic stroke severity and prognosis in patients with symptomatic carotid artery stenosis.

STUDY TYPE

Retrospective.

SUBJECTS

One hundred and ninty-three patients with least one confirmed carotid atherosclerotic stenosis ≥30% and cerebrovascular symptoms within the last 2 weeks (136 in the training cohort and 57 in the test cohort).

FIELD STRENGTH/SEQUENCE

3.0T, T2-weighted fluid attenuated inversion recovery (T2-FLAIR) and diffusion-weighted imaging (DWI); HRVW-MRI: 3D T1-weighted variable flip angle fast spin-echo sequences (VISTA), T2-weighted VISTA, simultaneous noncontrast angiography and intraplaque hemorrhage (SNAP), and contrast-enhanced T1-VISTA.

ASSESSMENT

The following features of the plaques or vessel wall were assessed by three MRI readers independently: calcification (CA), intraplaque hemorrhage (IPH), lipid-rich necrotic core (LRNC), ulceration, plaque enhancement (PE), maximum vessel diameter (Max VD), maximum wall thickness (Max WT), total vessel area (TVA), lumen area (LA), plaque volume, and lumen stenosis. WMLs were graded visually and categorized as absent-to-mild WMLs (Fazekas score 0-2) or moderate-severe WMLs (Fazekas score 3-6). WML volumes were quantified using a semiautomated volumetric analysis program. Modified Rankin scores (mRS) were assessed at 90 days, following an outpatient interview, or by telephone.

STATISTICAL TESTS

LASSO-logistic regression analysis was performed to construct a model. The performance of the model was evaluated using receiver operating characteristic (ROC) curve analyses, calibration curves, decision curve analyses, and clinical imaging curves. Conditional logistic regression analysis was used to explore the associations between the hybrid model-derived score and the modified Rankin Scale (mRS) score at 90 days.

RESULTS

The model was constructed using five selected features, including IPH, plaque enhancement, ulceration, NWI, and total Fazekas score in deep WMLs (DWMLs). The hybrid model yielded an area under the curve of 0.92 (95% confidence interval [CI] 0.87-0.97) in the training cohort and 0.88 (0.80-0.96) in the test cohort. Furthermore, the hybrid model-derived score (odds ratio = 1.28; 95% CI 1.06-1.53) was independently associated with the mRS score 90 days after stroke.

DATA CONCLUSIONS

The hybrid model constructed using MRI plaque characteristics and WML burden has potential to be an effective noninvasive method of assessing ischemic stroke severity. The model-derived score has promising utility in judging neurological function recovery.

LEVEL OF EVIDENCE: 4

TECHNICAL EFFICACY

Stage 2.

Intravascular enhancement sign at 3D T1-weighted turbo spin echo sequence is associated with cerebral atherosclerotic stenosis

OBJECTIVE

Intravascular enhancement sign (IVES) at three-dimensional T1-weighted turbo spin echo (3D T1W TSE) sequence may be a simple hemodynamic maker. This study aims to investigate the association between IVES and features of intracranial atherosclerotic stenosis (ICAS).

METHOD

Retrospective analysis of clinical and imaging data of patients who underwent high resolution-vessel wall imaging (HR-VWI) examination from May 2021 to May 2023. The number of IVES vessels and ICAS features at HR-VWI were extracted by two neuroradiologists. Paired comparisons and correlation analysis on these indicators were performed.

RESULTS

A total of 118 patients with ICAS in the first segment of the middle cerebral artery and accompanied by unilateral IVES were enrolled. Compared to the non-IVES side, a higher incidence of ischemic events and intraplaque hemorrhage (IPH), higher degree of vascular stenosis and enhancement, lower remodeling index, and lower signal intensity ratio (SIR) were found in subjects with IVES. In the ICAS with IVES, 79.66 % showed severe stenosis and occlusion; in the ICAS with severe stenosis and occlusion, 89.5 % showed IVES in the distal. A multivariable logistic regression model identified the vascular stenosis degree (OR = 1.922; 95 %CI [1.37-2.692]; P < 0.001), enhanced-degree (OR = 2.486; 95 %CI [1.315-4.698]; P = 0.005), position (OR = 2.869; 95 %CI [1.255-6.560]; P = 0.012), and SIR (OR = 0.032; 95 %CI [0.004-0.275]; P = 0.002) were independent association with the presence of IVES. The area under the curve was 0.911 for the use of IVES vessel quantities to identify severe stenosis and occlusion of arterial lumen.

CONCLUSION

The number of IVES vessels was associated with the local features of ICAS, which may indicate severe stenosis and occlusion in the major branches of the proximal artery.

Comparative analysis of imaging features and stroke-related factors between posterior circulation atherosclerosis and intramural hematoma-type dissection

AIM

To compare the features detected by high resolution magnetic resonance vessel wall imaging (HR-VWI) between posterior circulation atherosclerosis and intramural hematoma (IMH)-type dissection, and to identify indicators related to cerebral ischemic events.

MATERIALS AND METHODS

Clinical and HR-VWI data of 55 patients with posterior circulation IMH-type dissection and 132 patients with posterior circulation atherosclerosis collected between October 2017 and October 2023 were analyzed retrospectively. Two radiologists independently extracted the imaging features. Multivariable logistic regression was used to identify factors independently associated with stroke.

RESULTS

Compared with patients with atherosclerosis, those with IMH-type dissection were younger, with a lower prevalence of diabetes and hypertriglyceridemia, lower hypertension grade, enhanced grade, remodeling index (RI), vertebrobasilar artery/brainstem ratio, and prevalence of nonsmooth surface, and higher prevalence of intraluminal thrombus (ILT), lumen (LA), wall area (WA), and total vessel area (TVA). In patients with stroke, those with IMH-type dissection were younger, with a lower prevalence of diabetes, and degree of hypertension, and higher RI, WA, TVA, and the prevalence of ILT. Multivariable logistic regression showed that RI (odds ratio [OR], 0.37; 95% CI, 0.17-0.77) and normalized wall index (NWI) (OR, 39.02; 95% CI, 2.19-695.35) were risk factors for stroke in patients with dissection, and LA (OR, 1.52; 95% CI, 1.12-2.06) and NWI (OR, 60.84; 95% CI 3.70-998.06) were risk factors for atherosclerotic stroke.

CONCLUSION

Patients with posterior circulation IMH-type dissection had greater potential for positive remodeling than those with atherosclerosis. The arterial remodeling capacity was closely related to stroke risk.

The association between hyperhomocysteinemia and the prevalence of bilateral carotid atherosclerotic plaques in a middle-aged population

OBJECTIVE

We conducted a cross-sectional study to investigate the impact of hyperhomocysteinemia (HHcy) on the prevalence of CASP among middle-aged individuals, aiming to provide insights for CASP prevention.

METHODS

1105 subjects were categorized into HHcy group or normal tHcy group based on their plasma total homocysteine (tHcy). All participants underwent carotid artery ultrasonography to assess the presence of unilateral and bilateral CASP. Comparative analyses of demographic and clinical data were conducted between the two groups. Logistic regression and prespecified subgroup analyses were performed to determine whether HHcy independently contributed to bilateral CASP.

RESULTS

132 individuals exhibited bilateral CASP. The prevalence of bilateral CASP was significantly higher in the HHcy group compared to the normal tHcy group (21.55 % vs. 10.82 %, p = 0.003). Univariate logistic analysis showed a significant association between HHcy and the prevalence of bilateral CASP (OR = 2.056, 95 %CI 1.089-3.881, p = 0.026). In all four models of multivariate logistic analysis, HHcy consistently emerged as an independent risk factor for bilateral CASP, with odd ratios of 1.958, 2.047, 2.023, and 2.186. This association remained significant across all five subgroups stratified by age, sex, hypertension, diabetes, and BMI.

CONCLUSION

Our studies demonstrated HHcy was an independent risk factor for the prevalence of bilateral CASP in the middle-aged population. Theses results emphasized the importance of addressing HHcy in preventive strategies aimed at mitigating the burden of CASP among middle-aged individuals.