Retrospective study on the association between carotid plaque stability assessed by ultrasound imaging features and stroke risk

Background: Carotid plaque instability is a critical determinant of ischemic stroke risk. Identifying ultrasound imaging features associated with plaque vulnerability may enhance stroke risk stratification. Methods: This retrospective cohort study evaluated 225 patients (≥18 years) with carotid plaques identified by Doppler ultrasound at a tertiary hospital between January 2022 and December 2024. Patients were followed for 1 year and grouped by stroke outcomes. Baseline demographics, laboratory data, medication use, plaque characteristics (echogenicity, anatomical location, length, thickness, surface morphology, calcification, and intraplaque hemorrhage), intima-media thickness (IMT), neovascularization (graded by contrast-enhanced ultrasound), and plaque hardness (quantified by elastography) were analyzed. Results: < 0.05). Multivariate regression identified medium to high echogenicity, bifurcation location, plaque length >10 mm, intraplaque hemorrhage, higher neovascularization grade, and lower plaque hardness as independent predictors of stroke risk. Conclusion: Ultrasound imaging features of carotid plaques (echogenicity, location, length, intraplaque hemorrhage, neovascularization grade, and plaque hardness) are independently associated with stroke risk. These findings support the integration of advanced ultrasound imaging into clinical assessments to improve ischemic stroke risk stratification.