Evaluation of computed tomography angiography plaque thickness measurements in high-grade carotid artery stenosis.
OBJECTIVE
Increasing evidence suggests that carotid artery imaging can identify vulnerable plaque elements that increase stroke risk. We correlated recently proposed markers, soft and hard plaque thickness measurements on axial computed tomography angiography source images, with symptomatic disease status (ipsilateral stroke or transient ischemic attack) in high-grade carotid disease.


METHODS
Soft plaque and hard plaque thickness were measured with a recently validated technique using computed tomography angiography source images in subjects with ≥70% extracranial carotid artery stenosis. Logistic regression analyses were used to assess the strength of association between soft and hard plaque thickness measurements and previous stroke or transient ischemic attack. Receiver operating characteristic analysis was also performed.


RESULTS
Compared with asymptomatic subjects, those with symptomatic carotid disease had significantly larger soft plaque and total plaque thickness measurements and smaller hard plaque thickness measurements. Each 1-mm increase in soft plaque resulted in a 2.7 times greater odds of previous stroke or transient ischemic attack. Soft plaque thickness measurements provided excellent discrimination between symptomatic and asymptomatic disease, with receiver operating characteristic analysis showing an area under the curve of 0.90. A cutoff of 3.5-mm maximum soft plaque thickness provided a sensitivity of 81%, specificity of 83%, positive predictive value of 85%, and a negative predictive value of 78%.


CONCLUSIONS
Increasing maximum soft plaque thickness measurements are strongly associated with symptomatic disease status in carotid artery stenosis. Prospective validation of these results may translate into a widely accessible stroke risk stratification tool in high-grade carotid artery atherosclerotic disease.
From the Departments of Radiology (A.G., H.B., P.C.S.) and Neurology (H.K., A.M.), Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York; Department of Public Health, Weill Cornell Medical College, New York, NY (A.P., A.D., P.C.S.); and Department of Neurology, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York (R.S.M.).
Ajay
A
Gupta
Hediyeh
H
Baradaran
Hooman
H
Kamel
Ankur
A
Pandya
Atul
A
Mangla
Allison
A
Dunning
Randolph S
RS
Marshall
Pina C
PC
Sanelli
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000473:pathology*; D002533:Cerebral Angiography / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D002546:Ischemic Attack, Transient / Q000473:pathology; D008297:Male; D009333:Neck / Q000473:pathology; D058226:Plaque, Atherosclerotic / Q000473:pathology*; D011446:Prospective Studies; D012372:ROC Curve; D012044:Regression Analysis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000473:pathology; D014057:Tomography, X-Ray Computed
carotid arteries; ischemic attack, transient; stroke