Nonstenotic carotid artery plaques on computed tomography angiography in embolic stroke of undetermined source

Abstract

This study aims to evaluate the role of <50% stenotic cervical carotid artery plaques in embolic stroke of undetermined source (ESUS), focusing on plaque characteristics in symptomatic versus asymptomatic carotid arteries (contralateral). In this cross-sectional observational study, 81 patients who met the diagnostic criteria for ESUS and underwent were retrospectively analyzed. Carotid plaques causing <50% stenosis were examined, noting features such as plaque thickness, degree of luminal stenosis, irregularity, ulceration, calcification, and hypodensity. These characteristics were compared between the ipsilateral and contralateral carotid arteries. The study involved 33 men and 48 women, with plaques ≥3mm thick significantly more common in the ipsilateral carotid arteries (P < .05). Notable features such as plaque ulceration, irregularity, noncalcified plaque, and hypodensity were significantly more frequent ipsilaterally (P < .05). Of the plaque patients, 54.3% (44/81) were on the ipsilateral side, compared to 29.6% (24/81) on the contralateral side (P = .0024). Our findings underscore the potential significance of non-stenotic carotid plaques in ESUS. These plaques, especially those with certain high-risk characteristics, are more prevalent ipsilaterally and should be considered in clinical evaluations and treatment of ESUS.

Figure 1.

Axial (a) and sagittal (b) images showing a carotid bifurcation with irregular plaque-surface (arrows) in the proximal internal carotid artery.

Figure 2.

Three-dimensional CT angiography (a) and digital subtraction angiography (b) images showing a carotid bifurcation with irregular plaque ulceration (arrows).

Figure 3.

Enlarged axial CTA image of the proximal internal carotid artery in a patient with predominantly calcified plaque. The calipers represent maximum noncalcified plaque thickness, and double-headed arrow represent maximum calcified plaque thickness. CTA = computed tomography angiography.