Synergistic Predictive Effect Of Preoperative Integrated Assessment of Plaque Characteristics, Vascular Compliance and Blood Flow Parameters on the Risk of Restenosis After Symptomatic Carotid Artery Stenting.

OBJECTIVE

To evaluate the synergistic predictive value of an integrated preoperative assessment incorporating plaque characteristics, vascular compliance, and blood flow parameters for restenosis risk after symptomatic carotid artery stenting (CAS).

METHODS

This retrospective study analyzed 335 patients who underwent CAS (January 2021-January 2024) as a derivation cohort, classified into restenosis and non-restenosis groups based on 1-year follow-up. A prospective validation cohort included 60 additional patients (February-October 2024). Preoperative clinical and ultrasound data were compared. Feature selection was performed using least absolute shrinkage and selection operator (LASSO) regression. Independent predictors were identified via multivariate logistic regression, and a nomogram was constructed. The model's performance was assessed using the area under the receiver operating characteristic curve (AUC), calibration curves, and decision curve analysis to evaluate discrimination, calibration, and net benefit.

RESULTS

Significant differences were found in plaque echo, shape, calcification, distensibility coefficient (DC), stiffness index (SI), arterial compliance (AC), and peak systolic velocity (PSV) between groups (p < 0.05). LASSO regression selected five variables. Multivariate analysis confirmed plaque calcification (OR = 2.454, 95% CI: 1.457-4.133), DC (OR = 0.383, 95% CI: 0.224-0.655), SI (OR = 1.580, 95% CI: 1.244-2.007), AC (OR = 0.329, 95% CI: 0.182-0.596), and PSV (OR = 1.644, 95% CI: 1.279-2.113) as independent predictors (all p < 0.05). The model demonstrated excellent discrimination (AUC = 0.910, 95% CI: 0.868-0.953) and good calibration (p = 0.223), providing positive net benefit across threshold probabilities of 0.05-0.8. Validation confirmed robust performance (AUC = 0.886, 95% CI: 0.788-0.985; calibration p = 0.226).

CONCLUSION

A nomogram integrating preoperative plaque characteristics, vascular compliance, and hemodynamic parameters effectively predicts restenosis risk after CAS, supporting early risk stratification and personalized postoperative management to improve long-term patient outcomes.