What question did this study set out to answer?

This study aims to explore how calcification features of carotid plaques relate to vulnerability and risk of stroke.

June 5, 2026Open Access

Low Plaque Calcification Attenuation on CTA Marks Vulnerable Cervical Carotid Plaque Independent of Stenosis Severity

Key Points

This study aims to explore how calcification features of carotid plaques relate to vulnerability and risk of stroke.
Retrospective cross-sectional study analyzing symptomatic carotid plaques from registries.
Segments plaque calcifications using CTA to quantify total calcification volume, surface area, and attenuation.
Uses logistic regression to examine associations between calcification features and intraplaque hemorrhage.
Plaques with ≥70% stenosis had greater total calcification volume and surface area but lower attenuation compared to those with <50% stenosis (all P<0.001).
Lower calcification attenuation was significantly associated with ≥70% stenosis (OR: 0.89 per 100 HU increase, 95% CI: 0.86-0.93, P<0.001).
In IPH-positive plaques, lower attenuation and greater total calcification volume were associated with a higher risk of plaque vulnerability (both P<0.001).

Abstract

BACKGROUND AND PURPOSE: Carotid atherosclerotic stroke arises through overlapping hemodynamic and embolic mechanisms, yet management remains anchored to stenosis severity. Although stenosis reflects structural plaque burden, it incompletely captures plaque biology. We compared calcification features of symptomatic carotid plaques with ≥70% versus MATERIALS AND METHODS: A single-center retrospective cross-sectional study of ipsilateral symptomatic carotid plaques from two registries were compared: patients undergoing revascularization (≥70% stenosis) and patients with embolic stroke of undetermined source (RESULTS: Eighty-five patients were included (N=25, ≥70% stenosis and N=60, 2), and maximum diameter (15.0 vs 7.1mm), yet lower median attenuation (392 vs 504 HU) compared with PPPPP=.01) were associated with IPH-positive plaques. CONCLUSIONS: CTA-derived calcification attenuation, independent of stenosis severity and calcification burden, may provide insight into carotid plaque vulnerability and stroke mechanism beyond luminal narrowing.

Low Plaque Calcification Attenuation on CTA Marks Vulnerable Cervical Carotid Plaque Independent of Stenosis Severity

Key Points

Abstract

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