Keywords
medical radiology
carotid plaque
Doppler ultrasonography
plaque vulnerability
vessel wall imaging
How to Cite
Abstract
In press
Background. Non-stenotic extracranial atherosclerosis is increasingly regarded as a clinically relevant source of ischemic stroke, particularly when plaque vulnerability is present despite the absence of severe luminal narrowing.
Aim. To compare computed tomography, computed tomographic angiography, magnetic resonance imaging, ultrasonographic and integrated clinical-instrumental characteristics in ischemic stroke patients with stenotic and non-stenotic extracranial atherosclerosis.
Materials and Methods. The clinical observational comparative study with a cross-sectional analytical framework and retrospective and prospective components included 100 patients with verified non-lacunar ischemic stroke and ipsilateral extracranial atherosclerosis: 50 with stenotic (≥50% luminal narrowing of the culprit ipsilateral extracranial artery) and 50 with non-stenotic disease (<50%). MRI variables (median [Q1; Q3] for quantitative, n (%) for categorical) were analyzed using Shapiro–Wilk (normality), Mann–Whitney U, chi-square or Fisher’s exact (group comparisons), and Spearman’s correlation. Statistical analysis was performed using Statistica 8.0 (StatSoft, USA). The study was conducted as an aspect of the author’s dissertation and research project "Anatomical-functional and neurohumoral features of neurological consequences of traumatic and vascular injuries of the nervous system in different age periods" (state registration number 0121U000035).
Research Ethics. The study complied with medical research ethics standards of the World Medical Association Declaration of Helsinki (1964–2024). Written informed consent for examination, treatment and use of anonymized clinical data for research purposes was obtained from all participants or their legal representatives.
Results. Stenotic atherosclerosis was associated with lower ASPECTS (Alberta Stroke Program Early CT Score) (8.0 [7.0; 8.8] versus 9.0 [8.0; 9.0]; p<0.001), larger infarct volume (47.9 [35.8; 55.8] ml versus 33.2 [23.6; 39.2] ml; p<0.001), greater culprit stenosis and higher ipsilateral internal carotid artery flow velocities. Non-stenotic disease showed more frequent vulnerability markers: lower plaque gray-scale median, higher vulnerability score and high vulnerability in 64.0% versus 20.0% of patients (p<0.001). Early neurological deterioration was also more frequent in the non-stenotic group (30.0% versus 8.0%; p=0.005).
Conclusions. Stenotic disease formed a hemodynamic and large-infarct phenotype, whereas non-stenotic disease formed a vulnerability-driven phenotype requiring plaque-oriented risk stratification.
Keywords: neurology, medical radiology, carotid plaque, Doppler ultrasonography, plaque vulnerability, vessel wall imaging.
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