Carotid plaque mechanical heterogeneity and stroke risk: a comprehensive study integrating multi-site viscoelastic analysis and RADS classification

Q: What are the key findings of this study?

Plaques with high Plaque-RADS scores (category 4b) showed significantly higher viscoelastic indicators compared to low-score plaques, particularly at the base (D dispersion coefficient 9.49104, P < 0.05).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Carotid atherosclerosis (n=38). Intervention: High Plaque-RADS score (category 4b) vs. Low Plaque-RADS score (categories 2 and 3a). Primary outcome: D dispersion coefficient at the plaque base (p=<0.05).

Q: What does this research mean for the field?

Carotid plaques exhibit significant mechanical heterogeneity, and higher viscoelastic indicators at the plaque base and in hypoechoic regions correlate with higher Plaque-RADS scores. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To systematically evaluate the viscoelastic characteristics of carotid plaques across different anatomical locations and echogenicities, and to examine their relationship with Plaque-RADS risk classification scores.

Lijuan Wang; Shuang Zhang; Shan Gao; Jie Chen

doi:10.1186/s12872-026-06260-3

July 17, 2026BMC Cardiovascular DisordersOpen Access

Carotid plaque mechanical heterogeneity and stroke risk: a comprehensive study integrating multi-site viscoelastic analysis and RADS classification

View Full Paper

Ask AI

Bookmark

Share

Key result

High Plaque-RADS scores are linked to higher plaque viscoelasticity, particularly at the base.

P<0.05
n=38

Why the study?

Carotid plaque mechanical properties play a key role in ischemic stroke mechanisms, but their viscoelastic characteristics across plaque locations and echogenicities and relation to Plaque-RADS scores required systematic evaluation.

Key Points

To systematically evaluate the viscoelastic characteristics of carotid plaques across different anatomical locations and echogenicities, and to examine their relationship with Plaque-RADS risk classification scores.
Consecutively enrolled 38 patients with carotid atherosclerosis (mean age 66.5 ± 8.2 years; 30 males [78.9%], 8 females [21.1%]) evaluated between June and August 2025.
Analyzed 76 carotid plaques across multiple sites (proximal shoulder, base, distal shoulder, overall) and internal echogenic components using multi-site ultrasound shear wave elastography to measure stiffness (kPa), D dispersion coefficient (m/s/kHz), and V viscosity coefficient.
Stratified 71 evaluable plaques by Plaque-RADS scores (18 category 2 [23.7%], 50 category 3a [65.8%], and 3 category 4b [3.9%]) and compared mechanical properties using stratified analyses and multinomial logistic regression.
Plaque base stiffness (0.00, P < 0.001) was significantly higher than the proximal shoulder (90.00, P < 0.001), distal shoulder (90.00, P < 0.001), and overall plaque (15.00, P < 0.001), while viscosity was higher in the distal shoulder (4.53, P < 0.001) and overall region (4.91, P < 0.001).
On short-axis sections, the D dispersion coefficient differed significantly between hypoechoic and hyperechoic regions (P = 0.037), with hyperechoic-dominant mixed plaques independently linked to lower stiffness (p = 0.036) and hypoechoic-dominant mixed plaques to lower D dispersion coefficients (p = 0.037).
Plaques in Plaque-RADS category 4b demonstrated significantly elevated viscoelastic parameters compared to lower-risk categories, particularly at the base (D dispersion coefficient: 9.49104, P < 0.05; V viscosity coefficient: 7.55209, P < 0.05) and within hypoechoic regions (7.47948, P < 0.05).

Study Design

Type

Observational (n=38)

Multicenter

No

Structured PICO

P

Population

38 patients (mean age 66.5 years, 21.1% female) with carotid atherosclerosis who underwent multi-site viscoelastic ultrasound shear wave imaging of 76 plaques.

E

Exposure

Multi-site viscoelastic ultrasound shear wave imaging (Mindray Resona A20 with STVi software) to measure plaque stiffness (kPa), D dispersion coefficient (m/s/kHz), and V viscosity coefficient (Pa·s) at different locations and echogenicities.

O

Outcome

Viscoelastic characteristics of carotid plaques at different locations (proximal shoulder, base, distal shoulder, overall) and echogenicities, and their relationship with Plaque-RADS scores.surrogate

Main Result

p-value: p=<0.05

Multi-site viscoelastic ultrasound imaging reveals significant mechanical heterogeneity in carotid plaques, with elevated viscoelastic parameters correlating with high-risk Plaque-RADS scores, offering a potential non-invasive biomechanical marker for stroke risk.

Limitations

Small sample size
Single-center retrospective design
No histopathological validation
No longitudinal clinical follow-up
Small number of cases (only 3 plaques classified as Plaque-RADS 4b)
Retrospective nature of the analysis
Lack of histopathological validation (no carotid endarterectomy performed during the study period)
Measurements are vendor-specific and inter-vendor generalizability was not assessed

Implication

May support viscoelastic imaging for carotid plaque assessment; leaves open prospective validation for vulnerability prediction.

Abstract

Carotid atherosclerosis is one of the important etiologies of ischemic stroke, and the mechanical properties of plaques play a key role in the mechanisms of stroke occurrence. This study aims to systematically evaluate the viscoelastic characteristics of carotid plaques at different locations (proximal shoulder, base, distal shoulder, overall) and with different echogenicities (hypoechoic, hyperechoic), and to explore their relationship with Plaque-RADS scores. This study consecutively enrolled 38 patients with carotid atherosclerosis who visited our hospital from June to August 2025, with a total of 76 plaques analyzed. Multi-site viscoelastic ultrasound shear wave imaging was used to obtain plaque stiffness (kPa), D dispersion coefficient (m/s/kHz), and V viscosity coefficient. The stiffness of the plaque base (0.00, P < 0.001) was significantly higher than that of the proximal shoulder (90.00, P < 0.001), distal shoulder (90.00, P < 0.001), and overall plaque (15.00, P < 0.001). Viscosity was higher in the distal shoulder (4.53, P < 0.001) and overall region (4.91, P < 0.001); there was a significant difference in viscosity between hypoechoic and hyperechoic regions on the short-axis section ( P = 0.037). Furthermore, plaques with high Plaque-RADS scores (e.g., category 4b) showed significantly higher values in multiple viscoelastic indicators compared to low-score plaques, especially at the base (D dispersion coefficient: 9.49104, P < 0.05; V viscosity coefficient: 7.55209, P < 0.05) and in hypoechoic regions (7.47948, P < 0.05). These exploratory findings suggest that multi-site viscoelastic analysis may provide additional biomechanical information for plaque characterization. However, these results are hypothesis-generating rather than confirmatory. Further validation against histopathology, MRI-based plaque characterization, and prospective clinical outcomes is required before any clinical application can be considered.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Wang et al. (2026) conducted an observational in Carotid atherosclerosis (n=38). High Plaque-RADS score (category 4b) vs. Low Plaque-RADS score (categories 2 and 3a) was evaluated on D dispersion coefficient at the plaque base (p=<0.05). Plaques with high Plaque-RADS scores (category 4b) showed significantly higher viscoelastic indicators compared to low-score plaques, particularly at the base (D dispersion coefficient 9.49104, P < 0.05).

synapsesocial.com/papers/6a5b39118167787360d24ea6 https://doi.org/10.1186/s12872-026-06260-3

View Full Paper

Ask AI

Bookmark

Share

Carotid plaque mechanical heterogeneity and stroke risk: a comprehensive study integrating multi-site viscoelastic analysis and RADS classification

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Carotid plaque mechanical heterogeneity and stroke risk: a comprehensive study integrating multi-site viscoelastic analysis and RADS classification

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading