CTA plaque characteristics of non-stenotic carotid arteries in Mexican patients with ipsilateral embolic stroke of undetermined source and in patients with other neurological diagnoses

Christian E. Sanchez-Sanchez, Department of Neuroimaging, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City; Cadem Artista, Chopo Laboratories, Proa Medical Diagnostic Group, San Luis Potosi, S.L.P.; Mexico;
Vanessa Cano-Nigenda, Stroke Clinic, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City. Mexico;
Roger A. Carrillo-Mezo, Department of Neuroimaging, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City, Mexico;
Kevin Enriquez-Peregrino, Department of Emergency, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City. Mexico;
Rebeca de J. Ramos-Sanchez, Department of Neuroimaging, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City, Mexico;
Ana L. Calderon-Garcidueñas, Department of Neuropathology, Instituto Nacional de Neurologia y Neurocirugia “Manuel Velasco Suarez”, Secretaria de Salud, Mexico City. Mexico;
Antonio Arauz-Gongora, Cadem Artista, Chopo Laboratories, Proa Medical Diagnostic Group, San Luis Potosi, S.L.P., Mexico;

Introduction: Non-stenotic carotid plaque is associated with embolic stroke of undetermined source (ESUS). This study characterizes the morphology of non-stenotic carotid plaque using head and neck CTA in Mexican patients with ipsilateral ESUS and in patients without ESUS but with other neurological diagnoses. Material and methods: This cross-sectional study was conducted in patients with non-stenotic carotid plaque (< 50%). Only unilateral evaluation of the carotid artery was reported using head and neck CTA. Patients with non-stenotic carotid plaque were classified into two groups: those with ipsilateral ESUS and those without ESUS but with other neurological diagnoses. The characteristics of non-stenotic carotid plaque considered high-risk for ischemic stroke, and those not considered high-risk, a history of ipsilateral ischemic stroke, and a transient ischemic attack (TIA) were recorded. Results: We included 410 patients with non-stenotic carotid plaque assessed by head and neck CTA: 175 (42.7%) with ipsilateral ESUS and 235 (57.3%) without ESUS but with other neurological diagnoses, including aneurysm, intracranial hemorrhage, demyelinating disease, or epilepsy. In the ipsilateral ESUS group, the most frequent high-risk characteristics of non-stenotic carotid plaque were irregular surface (n = 168, 96.0%) and ulceration (n = 102, 58.3%), whereas punctate calcifications (n = 131, 74.8%) and plaque length ≥ 10 mm (n = 111, 63.4%) were not considered high-risk. In the group without ESUS, an irregular surface was observed in 218 (92.8%) and ulceration in 131 (55.7%); punctate calcifications, identified in 164 (69.8%), and plaque length ≥ 10 mm in 159 (67.6%), were not considered high-risk. None of the morphological characteristics of non-stenotic carotid plaque showed a significant association with ipsilateral ESUS. Conclusion: In Mexican patients with ipsilateral ESUS, high-risk morphological characteristics of nonstenotic carotid plaque on head and neck CTA included an irregular surface, ulceration, a lipid-rich necrotic core, and intraplaque hemorrhage. Comparable results were found in patients without ESUS but with other neurological diagnoses.

Keywords: Embolic stroke. Computed tomography angiography. Embolic stroke of undetermined source. Non-stenotic carotid plaque. High-risk carotid plaque.