Uric acid metabolism in carotid artery atherosclerosis-related stroke: Associations with plaque instability and ischemic lesion patterns.

BACKGROUND AND AIM: Serum uric acid (SUA) has been shown to involve in the pathogenesis of atherosclerosis and ischemic stroke. We aimed to investigate the association between SUA levels, carotid plaque instability, and acute ischemic lesion patterns in patients with advanced internal carotid artery (ICA) stenosis in this study.

METHODS AND

RESULTS

In this study, 1288 patients were initially recruited. After applying exclusion criteria, 403 patients with carotid artery stenosis (≥70 %) were included in the final analysis. Plaque instability was assessed using at least two vascular imaging techniques, also diffusion-weighted imaging (DWI) was used to classify ischemic lesion patterns as single or multiple scattered lesions within the ICA perfusion territory. Higher SUA levels were associated with irregular-ulcerated plaque surfaces (p < 0.001) and with multiple scattered acute ischemic lesions in the ICA perfusion territory on DWI (p < 0.001). SUA quartiles were defined as: ≤5.3 mg/dL (Q1), 5.31-6 mg/dL (Q2), 6.01-7 mg/dL (Q3), and ≥7.01 mg/dL (Q4). Patients within the highest SUA quartile (Q4) were displayed a positive correlation with unstable plaque surface (p = 0.002, r = 0.153) and had an independent association with an increased risk of multiple scattered ischemic lesions (p < 0.001; OR: 26.167; 95 % CI: 11.392-60.103).

CONCLUSIONS

Regardless of the severity of stenosis, our findings indicate that SUA may serve as a valuable parameter for identifying and monitoring plaque instability, especially in strokes characterized by acute scattered lesions. Integrating SUA evaluation into routine clinical practice may enhance patient management and follow-up strategies.