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April 1, 2010American Journal of NeuroradiologyOpen Access

Role of CT Angiographic Plaque Morphologic Characteristics in Addition to Stenosis in Predicting the Symptomatic Side in Carotid Artery Disease

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Key result

The presence of intraluminal thrombus on CTA was significantly associated with the symptomatic side in carotid disease (OR 3.1; P=0.048), while extensive calcification was protective.

Why the study?

Do CT angiographic plaque morphologic characteristics, in addition to stenosis, predict the symptomatic side in patients with carotid artery disease?

Population

673 patients presenting with hemispheric ischemic symptoms and having a CTA that included imaging of both…

Comparison

CT angiographic evaluation of carotid plaque… vs Contralateral asymptomatic carotid artery.

Design

Cross-sectional, Readers were blinded to the symptom side as well as other…

Authors

MEMuneer EesaMHMichael D. HillAAAli M. Al-Khathaami

Discussion

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Member takes

Overview

CT angiographic detection of intraluminal thrombus is highly predictive of the symptomatic side in carotid disease, while extensive calcification and smooth plaque appear protective, offering additional risk stratification beyond stenosis severity.

Study Design

Type

Observational (n=673)

Structured PICO

Do CT angiographic plaque morphologic characteristics, in addition to stenosis, predict the symptomatic side in patients with carotid artery disease?

P
Population
673 patients (408 men, 265 women; ages 18-91 years, mean 65.8 +/- 15.2 years) presenting with hemispheric ischemic symptoms (TIA/stroke) and having a CTA that included imaging of both carotid arteries within 24 hours.
I
Intervention
CT angiographic evaluation of carotid plaque morphologic features (plaque length, width, attenuation, shape, surface, calcification, and intraluminal thrombus) in addition to stenosis grade.
C
Comparator
Contralateral asymptomatic carotid artery (within-patient control).
O
Outcome
Symptomatic side status (ipsilateral carotid artery designated as the 'case', contralateral as the 'control').

Main Result

Effect estimate: OR 3.1

p-value: p=0.048

CT angiographic detection of intraluminal thrombus is highly predictive of the symptomatic side in carotid disease, while extensive calcification and smooth plaque appear protective, offering additional risk stratification beyond stenosis severity.

Limitations

  • Retrospective design
  • CT may not be adequate to demonstrate some features of complicated plaque such as intraplaque hemorrhage, neovascularity, and small surface ulcerations
  • Attenuation values were not objectively measured
  • Unclear whether the differences in scanner technology used (4-detector scanner versus 64-detector) had an effect on the data

Cite This Study

Eesa et al. (2010) conducted an observational in Carotid artery disease with symptomatic hemispheric TIA/stroke (n=673). CT Angiographic plaque morphologic characteristics (e.g., intraluminal thrombus) vs. Absence of specific plaque features / asymptomatic side was evaluated on Predicting the symptomatic side in carotid disease (multivariable model for intraluminal thrombus) (OR 3.1, p=0.048). The presence of intraluminal thrombus on CTA was significantly associated with the symptomatic side in carotid disease (OR 3.1; P=0.048), while extensive calcification was protective.

synapsesocial.com/papers/6a0f2caba7a2fed64abdc802https://doi.org/10.3174/ajnr.a2078
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Low-Grade Carotid Stenosis2005 · 200 citations
  2. 2Carotid Stenosis Index Revisited With Direct CT Angiography Measurement of Carotid Arteries to Quantify Carotid Stenosis2006 · 65 citations
  3. 3Ultrasound and Lipoproteins as Predictors of Lipid-Rich, Rupture-Prone Plaques in the Carotid Artery1999 · 192 citations
  4. 4Carotid Artery Atherosclerosis: In Vivo Morphologic Characterization with Gadolinium-enhanced Double-oblique MR Imaging—Initial Results2002 · 334 citations
  5. 5Visualization of Fibrous Cap Thickness and Rupture in Human Atherosclerotic Carotid Plaque In Vivo With High-Resolution Magnetic Resonance Imaging2000 · 632 citations