Quantitative Analysis Of Carotid Plaque Components To Assess The Risk Of Acute Ischemic Stroke

Objective:To evaluate the predictive value of quantitative analysis of plaque composition for acute ischemic stroke(AIS),we studied the correlation between carotid plaque burden and categorical variables of plaque composition,and numerical variables with AIS in patients with carotid atherosclerotic stenosis.Methods:From December 2020 to December 2022,99 patients with carotid atherosclerotic stenosis admitted to the Department of Neurosurgery and Neurology of the Inner Mongolia Autonomous Region People’s Hospital who received high-resolution magnetic resonance imaging(HR-MRI)examination of the carotid artery were collected as the research objects.Patients with poor imaging data,postoperative or occlusion of the internal carotid artery,stenosis of the ipsilateral intracranial segment of the lesion,failure to receive DWI examination and possible cerebral embolism caused by other reasons were excluded,Baseline data of patients were collected,and MRI images of carotid plaque were analyzed using the MRI-Plaque view software.Classification variables and numerical variables related to carotid plaque load and plaque components were collected.The subjects were divided into two groups based on the presence or absence of AIS.Variance analysis was performed on the above variables.Logistic regression models were constructed using the input method,and prediction probabilities were calculated.Receiver operating characteristic(ROC)curves were drawn,The sensitivity and specificity of the model for predicting AIS were obtained from the maximum Joden index.Results:Excluding 2 cases of internal carotid artery occlusion,2 cases of internal carotid artery surgery,and 3 cases of image quality score≤2,this study ultimately included 92 patients,with a sample age of(61.39±7.65)years,83(90.2%)male patients,37(40.2%)AIS patients,and a carotid plaque volume of(557.32±237.07)mm~3.There was no statistically significant difference in baseline data between patients in the AIS group and those in the non-AIS group(P>0.05).In terms of plaque load,there were statistically significant differences between the two groups in tube wall volume,average tube wall thickness,and maximum tube wall thickness(P<0.05);The difference between the maximum normalized wall index(NWI)and the average lumen area was statistically significant(P<0.001);There was no statistically significant difference in average wall area,maximum wall area,and average NWI(P>0.05).There was no significant difference in the presence of lipid-rich necrotic core(LRNC)in carotid plaque between the two groups(P>0.05);There were significant differences in LRNC volume,LRNC volume percentage,and LRNC maximum area percentage(P<0.001).There were statistically significant differences in the presence,volume,percentage of IPH volume,and percentage of the maximum area of IPH between the two groups(P<0.001).There was no significant difference in the presence of calcification and the percentage of maximum calcification area between the two groups(P>0.05);The difference in calcification volume and calcification volume proportion was statistically significant(P<0.05).The difference between the two groups in thin fiber cap,fiber cap rupture,and vulnerable plaque was statistically significant(P<0.05).Logistic regression analysis including LRNC maximum area percentage,IPH maximum area percentage,calcification maximum area percentage,maximum NWI,and thin fiber cap showed that maximum NWI was an independent risk factor for AIS(OR=1.211,95%CI 1.076-1.364,P=0.002);The maximum area percentage of LRNC is an independent risk factor for AIS(OR=1.121,95%CI 1.035-1.214,P=0.005);Independent risk factor for AIS in percentage of maximum area of IPH(OR=1.457,95%CI 1.174-1.808,P=0.001).The percentage of maximum calcification area and thin fiber cap had no statistically significant impact on the outcome.The ROC curves of LRNC maximum area percentage,IPH maximum area percentage,calcification maximum area percentage,maximum NWI,and thin fiber cap were plotted to jointly predict AIS.The area under the curve(AUC)was 0.964(95%CI 0.933-0.995,P<0.001).The specificity was 0.873 and the sensitivity was 0.946.Conclusions:The percentage of the maximum area of carotid atherosclerotic plaque IPH and the percentage of the maximum area of LRNC are independent risk factors for AIS.The combination of quantitative analysis of carotid artery plaque components and diagnosis can effectively assess the risk of AIS occurrence,which is helpful for the selection of clinical treatment strategies for patients with carotid artery stenosis.