Carotid Plaque Composition Assessed by CT Predicts Subsequent Cardiovascular Events among Subjects with Carotid Stenosis

Abstract

BACKGROUND AND PURPOSE: Currently, the characteristics of carotid plaques are considered important factors for identifying subjects at high risk of stroke. This study aimed to test the hypothesis that carotid plaque composition assessed by CTA is associated with an increased risk of future major adverse cardiovascular events among asymptomatic subjects with moderate-to-severe carotid artery stenosis. MATERIALS AND METHODS:This single-center, retrospective cohort study included 194 carotid plaques from 176 asymptomatic subjects with moderate-to-severe carotid artery stenosis. The association of CTA-determined plaque composition with the risk of subsequent adverse cardiovascular events was analyzed.RESULTS: During a median follow-up of 41 months, the adverse cardiovascular event incidence among 194 carotid plaques was 19.6%. There were significant differences in plaque Hounsfield units (P , .001) and spotty calcium presence (P , .001) between carotid plaques from subjects with and without subsequent adverse cardiovascular events. Multivariable analysis revealed carotid plaque Hounsfield unit density (P , .001) and spotty calcium (P , .001) as independent predictors of subsequent adverse cardiovascular events. In association with moderate carotid artery stenosis, the plaque Hounsfield unit values were significantly lower among carotid plaques from subjects who experienced subsequent adverse cardiovascular events (P ¼ .002), strokes (P ¼ .01), and cardiovascular deaths (P ¼ .04); the presence of spotty calcium was significantly associated with the occurrence of adverse cardiovascular events (P ¼ .001), acute coronary syndrome (P ¼ .01), and cardiovascular death (P ¼ .04).CONCLUSIONS: Carotid plaque Hounsfield unit density and spotty calcium were independent predictors of a greater risk of adverse cardiovascular event occurrence. ABBREVIATIONS: ACS ¼ acute coronary syndrome; CAS ¼ carotid artery stenosis; DUS ¼ Doppler ultrasound; HR ¼ hazard ratio; IQR ¼ interquartile range; MACE ¼ major adverse cardiovascular event

Carotid Artery Disease in the Era of Biomarkers: A Pilot Study

“…From mild fatty deposition in asymptomatic patients to complex, irregular plaques prone to the thromboembolism, DUS, CT scan, and highresolution MR can provide significant information [34,35]. DUS is useful in determining hemodynamic features; Choi E. et al report how CT scans help to assess the composition of plaque, with Hounsfield unit density and spotty calcium considered independent predictors of a greater risk of adverse cardiovascular event occurrence; Porambo ME et al underline the ability of MR in the study of vulnerability plaque showing thoroughly lipid-rich necrotic core, thin/ruptured fibrous cap, and intraplaque hemorrhage, predicting factors of future stroke [36,37]. However, every imaging method can be a source of information about carotid plaques with DUS representing the first line of approach to CAAD, and CT scans and MR are useful tools to identify patients with high risk [38].…”

Large unstained cell (LUC) count as a predictor of carotid artery occlusion

“…10 However, studies examining the makeup of plaques and subsequent remodeling and influence on mechanical forces should be taken into consideration with the use of ultrasound Doppler, computed tomography (CT) and positron emission tomography (PET), or magnetic resonance imaging (MRI) for predicting possible complications. [11][12][13] Atherosclerosis is considered a lipid-derived disease with an inflammatory background. 14 The inflammatory reactions initiate the formation of plaques if the endothelium becomes dysfunctional, while also facilitating disease progression.…”