Abstract TP176: Radiological Reporting Frequencies of High-Risk Non-Stenosing Carotid Plaque Features: A Follow-Up Observational Study

Abstract

Background: High-risk non-stenosing carotid plaque features are emerging as a possible source of embolism in the setting of ESUS. Unless there is a hemodynamically significant stenosis, neuroradiology reports tend to be rarely descriptive of these features. Methods: In our previous study published in September 2022, we analyzed a patient sample drawn from the stroke registry of the HFHS between June 2016 and June 2021. Our results showed a higher incidence of high-risk plaque features including plaque ulceration (19.08% vs 5.26%, p<0.0001), plaque thickness >3mm: (19.08% vs 7.24%, p=0.001), and length >1cm (13.16% vs 5.92%, p=0.0218) ipsilateral to ESUS. In this subsequent study, we utilized the same patient dataset and used CTA reports on EPIC to explore how frequently neuroradiologists had mentioned those features. We utilized Fisher’s exact test to compare the frequencies of reporting each plaque characteristic. Results: We analyzed 152 CTA reports in depth. Our findings indicate that the frequency of reporting plaque ulceration compared to the frequency of reporting plaque calcification was significantly different (8.1% vs 100%, p< 0.00001), this is also noticed with plaque length (4.6%, p< 0.00001) and soft plaques (72.1%, p< 0.00001). Notably, none of the CTA reports had commented on any plaque thickness or the presence of any “high-risk” features when encountering stroke ipsilaterally. Conclusion: When carotid plaques are not causing hemodynamically significant stenosis, neuroradiology reports frequently mention the density of plaques, but unfortunately overlook other characteristics. It is essential to conduct algorithms, scoring systems and prediction models to determine which plaque features are highly associated with embolism. These models should help prioritize the description of these features, alongside commonly reported metrics such as plaque density and the degree of stenosis.