Plaque Volume Rather than Echogenicity for Identification of Active Carotid Plaques

This single-center prospective observational follow-up study aimed to evaluate 2-year changes in carotid plaque volume and echogenicity and to explore whether clinical and biochemical baseline factors are associated with plaque progression. It was an exploratory observational follow-up of patients with echolucent plaques previously enrolled in a 12-month randomized controlled trial. Plaque volume and grayscale median were measured at baseline and at 3, 6, 12, and 24 months using three-dimensional ultrasound (3D-US). Associations between baseline characteristics and plaque progression were evaluated using mixed-effects models with time-predictor interactions, adjusted for baseline plaque volume. Medication adherence from 12 to 24 months was examined. Plaque echogenicity remained stable over 24 months, whereas mean plaque volume increased with heterogeneous patterns. Approximately 20% of plaques were classified as progressors, 70% as stable, and 10% as regressors. Higher mean arterial pressure, low density lipoprotein cholesterol (LDL-C), and larger baseline volume were significantly associated with plaque progression. Poor statin adherence showed a non-significant trend toward greater progression. In conclusion, echolucent carotid plaques demonstrated stable echogenicity but volumetric progression over 24 months. Blood pressure, LDL-C, and baseline plaque size were associated with progression, although limited by sample size, supporting a role for longitudinal 3D-US plaque volume assessment in individualized cardiovascular prevention.