Quantitative ultrasound assessment of carotid atherosclerosis in ischemic stroke risk stratification

Objective. To evaluate the role of quantitative ultrasound parameters of atherosclerotic plaque (ASP) as predictors of the development of the primary composite endpoint in patients with carotid atherosclerosis.

Materials and methods. A total of 675 patients with carotid atherosclerosis with no history of transient ischemic attack or ischemic stroke at the time of inclusion in the study were examined; 48.4% were men, with an average age of 66 [61; 72] years. All patients underwent electrocardiography, echocardiography, carotid arteries duplex ultrasound with assessment of the degree of stenosis according to NASCET and maximum wall thickness (MWT) of plaque with subsequent analysis of ASP images in DICOM format. A computer software (own development) was used to calculate the total area of the ASP and segment the image by grayscale ranges (“blood”, “lipids”, “muscle and fibrous components”, and “calcium”). The observation period was 5 years. The primary composite endpoint was the development of an ischemic event in the carotid territory on the affected side or surgical treatment of carotid stenosis. Differences were considered statistically significant at p < 0.05.

Results. During the follow-up period, 85 patients (12%) achieved primary composite endpoint. This event occurred 3 and 10 times more frequently in patients with Gray-Weale ASP types I and II than in those with types III and IV, respectively. Independent predictors in the five-year risk stratification model for event development included the NASCET stenosis grade, MWT, and the plaque image segmentation parameters excluding the “fibrous component”. Patients were divided into three groups: a “high-risk” group for developing primary composite endpoint (the predicted overall five-year risk (OR) was 30% or more) – 136 patients (21%), a “low-risk” group (less than 15% OR) – 405 patients (64%), and a “medium (intermediate) risk" group (from 15% to 30% OR) – 99 patients (15%). The median values of the degree of stenosis according to NASCET and the MWT were 15 [4; 25]% and 2.5 [2.1; 3.1] mm for the low-risk group, 24 [14; 27]% and 3.0 [2.5; 3.6] mm for the average risk group, and 50 [38; 69]% and 4.3 [3.8; 5.5] mm, respectively (p < 0.0001).

Conclusions. The degree of stenosis according to NASCET, MWT and the results of segmentation of the gray-scale image of the ASP by gray-scale ranges are significant independent predictors of the development of primary composite endpoint in asymptomatic patients with carotid atherosclerosis. 

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