Cerebrovascular diseases extra · 2026
Beyond Stenosis: Prevalence and the Characteristics of Nonstenotic Carotid Plaques in Embolic Stroke of Undetermined Source.
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Natarajan Manuraj, Kumar Adarsh Anil, Vijayaraghavan Asish, Kannoth Santhosh, Erat Sreedharan Sapna, Karuthedathu Mana Sanal Kumar Arya Devi, Sylaja Padmavathy Narayanan
Аннотация
INTRODUCTION: Nonstenotic carotid plaques, despite being considered low risk for stroke, are increasingly recognized to contribute to embolic strokes of undetermined source (ESUS). Emerging evidence indicates that rather than the degree of stenosis, high-risk plaque characteristics like plaque irregularity and intraplaque hemorrhage may increase the embolic risk. We analyzed the prevalence and characteristics of nonstenotic carotid plaques in ESUS and their implications for stroke recurrence risk.
METHODS: We retrospectively identified 274 patients with ESUS between 2012 and 2022. The computed tomography angiograms were analyzed for nonstenotic carotid plaques (<50% stenosis, as per NASCET criteria) by blinded neuroradiologists. The infarct patterns and plaque characteristics were evaluated. The stroke recurrences at 3 months and 1 year were noted.
RESULTS: The mean age of the study population was 57.99 ± 12.86 years, and 65.3% were males. The nonstenotic plaques (30-50% stenosis) were more common on the symptomatic side of stroke (13.3% vs. 7.3%, p = 0.026). Plaques with irregularity were also more frequent on the symptomatic side (16.4% vs. 9.7%, p = 0.023). Patients with symptomatic nonstenotic plaques had a higher incidence of embolic (25% vs. 5%, p = 0.000) and watershed infarcts (16.7% vs. 4.6%, p = 0.005). The stroke recurrence risk and mortality at 3 months and 1 year did not differ between the 2 groups.
CONCLUSION: In this single-center retrospective study, nonstenotic carotid plaques with 30-50% stenosis were more prevalent on the symptomatic side, suggesting a potential role in stroke mechanism. The higher rates of embolic and watershed infarcts and the presence of plaque irregularity on the symptomatic side support this association.
METHODS: We retrospectively identified 274 patients with ESUS between 2012 and 2022. The computed tomography angiograms were analyzed for nonstenotic carotid plaques (<50% stenosis, as per NASCET criteria) by blinded neuroradiologists. The infarct patterns and plaque characteristics were evaluated. The stroke recurrences at 3 months and 1 year were noted.
RESULTS: The mean age of the study population was 57.99 ± 12.86 years, and 65.3% were males. The nonstenotic plaques (30-50% stenosis) were more common on the symptomatic side of stroke (13.3% vs. 7.3%, p = 0.026). Plaques with irregularity were also more frequent on the symptomatic side (16.4% vs. 9.7%, p = 0.023). Patients with symptomatic nonstenotic plaques had a higher incidence of embolic (25% vs. 5%, p = 0.000) and watershed infarcts (16.7% vs. 4.6%, p = 0.005). The stroke recurrence risk and mortality at 3 months and 1 year did not differ between the 2 groups.
CONCLUSION: In this single-center retrospective study, nonstenotic carotid plaques with 30-50% stenosis were more prevalent on the symptomatic side, suggesting a potential role in stroke mechanism. The higher rates of embolic and watershed infarcts and the presence of plaque irregularity on the symptomatic side support this association.