Value of Intraplaque Neovascularization on Contrast-Enhanced Ultrasonography in Predicting Ischemic Stroke Recurrence in Patients With Carotid Atherosclerotic Plaque

Independent predictors of ischemic stroke: a comprehensive scan of the internal carotid and vertebrobasilar systems

Background

Stroke has the highest individual disability rate of all ischemic cardiovascular diseases. Thus, the early identification of its risk factors are crucial to reduce its incidence and improve unfavorable prognoses. This study investigated the value of the most reliable predictors of ischemic stroke by comprehensively scanning the internal carotid artery system and vertebrobasilar artery system using integrated cervicocerebral ultrasound (ICCUS).

Methods

Patients who had undergone ICCUS scanning and who had recently had a non-cardiac ischemic stroke (<30 days) were prospectively included in this study. Relevant ICCUS parameters were recorded for the carotid, vertebral, subclavian, and intracranial arteries, and intracranial collaterals. The independent predictors of ischemic stroke were examined by multivariate logistic regression analysis. The receiver operating characteristic curves and area under the curve (AUC) were used to evaluate the predictive effects.

Results

From July 2023 to April 2024, 127 patients were included in the final analysis, of whom, 42 had suffered a stroke and 85 had not suffered a stroke. The multivariate logistic regression analysis showed that the presence of intraplaque hemorrhage (IPH), multiple stenoses in the anterior and posterior cerebral arteries, and opening of the anterior communicating artery within the cerebral collateral on ICCUS scanning were independent predictors of ischemic stroke (all P<0.05). The corresponding odds ratios for these factors were 5.20, 21.63, 19.87, and 4.58, respectively, and the AUC was 0.802 (95% confidence interval: 0.71-0.89, P<0.001). In addition, if the IPH predictor for cervical vessels was combined with any of the one to three predictors for the intracranial vessels, the combined the diagnostic accuracies progressively increased to 68.1-71.4%, 74.5-76.0%, and 80.2%, respectively.

Conclusions

This study used ICCUS, a comprehensive, accurate, and efficient ultrasound technology, to identify more reliable independent predictors of ischemic stroke. Our findings may guide the early prevention and timely treatment of patients.

Prediction of ischemic stroke in elderly hypertensive patients using carotid plaque superb microvascular imaging characteristics: a lasso-logistic regression model

PURPOSE

This study aims to assess the effectiveness of Superb Microvascular Imaging (SMI) in evaluating intraplaque neovascularization (IPN) in carotid plaques and its association with ischemic stroke in elderly hypertensive patients, and to develop and validate a prediction model for ischemic stroke based on SMI characteristics.

METHODS

This retrospective study included 314 elderly hypertensive patients with carotid plaques, divided into a training cohort (235 cases) and a validation cohort (79 cases). Patients were categorized into stroke and non-stroke groups. SMI characteristics of carotid plaques and baseline variables were analyzed using univariate logistic regression and Least Absolute Shrinkage and Selection Operator (LASSO) regression to develop a multivariate logistic regression model. The model was then validated.

RESULTS

In the training cohort, 79 patients (33.6%) experienced ischemic stroke. Significant predictors included BMI, hypertension grade, IPN grade, and stenosis percentage. These factors were incorporated into a logistic regression model, which was validated with an area under the curve (AUC) of 0.79, 69.6% accuracy, 60.8% sensitivity, and 85.7% specificity.

CONCLUSION

BMI, hypertension grade, IPN grade, and carotid plaque stenosis are associated with ischemic stroke in elderly hypertensive patients. The developed logistic regression model based on these indicators can improve the prediction of ischemic stroke in this population.

Incremental clinical value of intraplaque neovascularization in predicting recurrent ischemic stroke

OBJECTIVE

Carotid intraplaque neovascularization (IPN) detected by contrast-enhanced ultrasound (CEUS) is a risk factor for recurrent ischemic stroke. However, it is still unclear whether IPN can be used to accurately identify patients with recurrent ischemic stroke in clinical practice. Herein, we investigated the clinical predictive value of IPN for recurrent ischemic stroke in a real-world setting.

METHODS

We enrolled 200 patients with ischemic stroke and atherosclerotic carotid stenosis who were followed up for 2 years. The endpoint was recurrent ischemic stroke. Cox regression and subgroup analyses were employed to assess whether treatment affected the relationship between IPN and recurrent ischemic stroke. The net classification index (NRI) and integrated discriminant improvement index (IDI) were used to validate the additional clinical value of IPN in identifying recurrent ischemic stroke.

RESULTS

During the 2-year follow-up, 36 patients experienced recurrent ischemic stroke. Cox regression analyses showed that IPN (grade 2), hypoechoic plaque, high homocysteine levels, and smoking were independent risk factors for recurrent ischemic stroke. Additional IPN evaluation may increase the NRI (0.512; 95% confidence interval [CI]: 0.083-0.624) and IDI (0.151; 95% CI: 0.010-0.213) for identifying high-risk patients with recurrent ischemic stroke. In addition, in the subgroup undergoing revascularization, the proportion of IPN (grade 2) was significantly higher in patients with recurrent ischemic stroke than in patients with nonrecurrent ischemic stroke (p = 0.001).

INTERPRETATION

In clinical settings, IPN, assessed by CEUS, may provide additional clinical value for predicting recurrent ischemic stroke, helping to identify patients with ischemic stroke who require close follow-up.