ABSTRACT Carotid atherosclerosis is a major pathological basis of cardiovascular and cerebrovascular diseases, and early detection of carotid plaques is clinically important for preventing stroke. However, accurate plaque identification in medical images is challenging, particularly with limited sample sizes. This study proposes a deep learning–based multi-fusion model for automatic carotid plaque detection. A dual-input Bilinear CNN (BCNN) based on ResNet-50 is developed to enhance plaque recognition by fusing convolutional features from different channels. The dataset includes 1,291 carotid ultrasound images from 985 patients, which were standardised and enhanced. Internal and external validation results show that the BCNN ResNet model achieves AUC values of 0.99 and 0.98, respectively, outperforming the traditional ResNet-34 model. The model also generates visual heatmaps, demonstrating good interpretability and accurate focus on plaque regions. Overall, the proposed model effectively identifies carotid plaques under small-sample conditions and provides a promising tool for auxiliary diagnosis and early intervention in cardiovascular and cerebrovascular diseases.

Molecular Imaging of Fibroblast Activation Protein on PET/MRI: Association With Carotid-Ulcerated Plaques and Cerebrovascular Risk Factors.

AI-ECG age predicts carotid atherosclerotic plaque volume and progression.

Computed tomography angiography identifies nonstenotic extracranial plaque features susceptible to stroke.

Carotid plaque heterogeneity and lower calcified volume on computed tomography angiography are associated with neurologic symptoms.

Association between exposure to selected endocrine-disrupting chemicals and subclinical carotid atherosclerosis: A systematic review and meta-analysis.

Physical activity in carotid atherosclerotic patients blunts monocyte pro-inflammatory processes: a randomised controlled trial.

The subendocardial viability ratio (SEVR) reflects myocardial perfusion relative to workload. This study explored the association of SEVR with mortality and subclinical target organ damage in an older adult population. We analyzed the data from the Northern Shanghai Study, a community-based cohort of older adults aged over 65 years. SEVR was measured with arterial tonometry. Cross-sectional associations were assessed between SEVR levels and target organ damage (including arterial stiffness, peripheral artery disease, carotid plaque, left ventricular hypertrophy, left ventricular diastolic dysfunction, chronic kidney dysfunction, and microalbuminuria). Longitudinal associations between SEVR and mortality were evaluated using Cox and Fine-Gray models. Among 3237 participants (mean age 71±6 years, 57% female), 233 deaths occurred over a median follow-up of 5.7 years, including 94 cardiovascular deaths. Participants were divided into 2 groups by the median value of SEVR (129%). The group with a lower SEVR (≤129%) was associated with higher risk of cardiovascular death (adjusted CoxHazard Ratio [HR]=1.70 [1.05-2.75]; P=0.03), but not with all-cause death (adjusted CoxHR=1.30 [0.98-1.73]; P=0.07). As for target organ damage, participants with more damaged organs had lower SEVR values (P for trend <0.001). Specifically, the occurrence of arterial stiffness and left ventricular diastolic dysfunction increased the potential of worse SEVR, with odds ratio 1.46 (1.17-1.83); P<0.001, and 1.90 (1.35-2.67); P<0.001, respectively. Lower SEVR is independently associated with both increased cardiovascular mortality and organ damage, including arterial stiffness and left ventricular diastolic dysfunction in older adult populations. SEVR may be a convenient marker for early cardiovascular risk stratification in aging populations. URL: https://ClinicalTrial.gov; Unique Identifier: NCT02368938.

BackgroundCerebrovascular disease (CVD) is a leading cause of mortality with a strong link to cognitive impairment and dementia. White matter lesions (WML) are prevalent in CVD and are early markers of vascular compromise, particularly in relation to intraplaque hemorrhage (IPH), an indicator of carotid artery plaque instability. As vascular disease represents a possible treatment window for dementia subjects, this study explores the relationship between hemispheric WML asymmetry and IPH utilizing a large multicenter cohort to find novel biomarkers of disease.MethodFLAIR MRI scans of 264 subjects from the Canadian Atherosclerosis Imaging Network were categorized as IPH positive (IPH+) or IPH negative (IPH‐) and WML biomarkers were automatically computed (Figure 1). Biomarkers related to WML prevalence (volume) and WML ischemia and progression (intensity) were extracted: ICV‐normalized WML volume (WML‐ICV), WML mean intensity (WML‐Intensity), and WML intensity ratio (WML‐IR). WML asymmetry was assessed via an asymmetry index measure (AIM). Linear mixed models and regression analyses were conducted, with adjustments for age, sex, scanner manufacturer, and stenosis, to evaluate associations between WML biomarkers and IPH status.ResultIPH+ patients exhibited significant rightward asymmetry in WML‐ICV (0.0032 ± 0.002, p < 0.05), WML‐Intensity (7.26 ± 5.41, p < 0.05), and WML‐IR (0.0271 ± 0.0204, p < 0.05); Table 1. IPH+ subjects (left, right or bilateral) had more lesions that were brighter in the right hemisphere. This trend was most pronounced in younger male patients (<65 years), suggesting a high‐risk demographic. Regression analysis revealed IPH as a significant predictor of WML asymmetry, with stronger effects observed in subjects with IPH in the right carotid artery.ConclusionPrevious studies suggest more injury in the right hemisphere for subjects with small vessel disease, and this work supports this finding. With rightward WML asymmetry being strongly associated with IPH, this could be reflecting a surrogate marker for overall vascular disease and its contribution to brain health and dementia. Automated WML biomarkers can be used to identify these high‐risk patients and guide early interventions for subjects with vascular disease and dementia. Future work should validate these findings in larger, longitudinal datasets to enhance clinical applications.

Complicated carotid artery plaques (cCAP), characterized by intraplaque haemorrhage (IPH), thin or ruptured fibrous caps, and/or superimposed thrombi pose a high stroke risk. The role of individual carotid geometry and local haemodynamics - such as wall shear stress (WSS) and oscillatory shear index (OSI) - in the development of cCAP is insufficiently understood. This study aimed to identify imaging- and blood-based biomarkers associated with the presence of cCAP to improve individual risk stratification. We prospectively recruited 141 consecutive patients with 20-80% ICA stenosis (NASCET criteria) at a tertiary stroke centre. Using 3D high-resolution multi-contrast MR plaque imaging and 4D flow MRI, we assessed plaque composition, vascular geometry, and local haemodynamics, alongside blood biomarker profiling. Multivariable logistic regression models determined independent associations with cCAP. We identified cCAP in 64/220 included carotid arteries (29.1%) among 57/129 patients (44.2%; 30.2% women, 72.8 ± 8.68 years). Female gender was inversely associated with cCAP (OR 0.32, p = 0.02), adjusting for age, wall thickness, cardiovascular risk factors and geometric and haemodynamic parameters. Patients with cCAP showed a lower ICA-CCA ratio (p = 0.018). Increased systolic WSS (OR 1.54, p = 0.020) and low OSI (OR 0.67, p = 0.044) were independently correlated with cCAP after adjustment. Blood biomarkers showed no significant correlation. In patients with up to 80% ICA stenosis, male gender, elevated systolic WSS and reduced OSI were independently associated with the presence of cCAP, with group differences noted for ICA/CCA ratio. Our findings highlight the importance of geometric and haemodynamic biomarkers for individual stroke risk stratification.

Association of the triglyceride-glucose index and its derived indices with carotid artery plaques in postmenopausal women: a cross-sectional study.

In the etiologic assessment of ischemic stroke, conventional imaging techniques may underestimate the clinical significance of high-risk plaques that do not exhibit significant luminal stenosis. Here, we report the case of a 66-year-old male patient who experienced 3 recurrent strokes. Carotid ultrasound and digital subtraction angiography showed no apparent carotid stenosis. However, high-resolution MRI and postoperative pathology revealed a plaque in the common carotid artery with vulnerable features including positive remodeling, fibrous cap rupture, and intraplaque hemorrhage. This case highlights that vulnerable plaques can pose a risk of stroke even when stenosis is only mild and underscores the pivotal role of high-resolution imaging techniques in identifying plaque characteristics to refine stroke etiology assessment. This case provides valuable insight into the high-risk nature of nonstenotic plaques and supports the optimization of stroke risk stratification strategies.

Purpose: Fragmented QRS (fQRS) is an electrocardiographic marker of depolarization abnormalities related to myocardial fibrosis. Although fQRS has been linked to adverse cardiovascular outcomes, its relationship with vascular remodeling in hypertension remains unclear. This study aimed to investigate the association between fQRS, left ventricular hypertrophy (LVH), and carotid artery disease in hypertensive patients. Materials and Methods: A total of 292 patients with essential hypertension were enrolled and stratified into two groups according to the presence (n = 128) or absence (n = 164) of fQRS on 12-lead electrocardiography. All participants underwent transthoracic echocardiography to determine left ventricular mass (LVM) and left ventricular mass index (LVMI), as well as carotid ultrasonography for measurement of carotid intima-media thickness (CIMT) and plaque detection. Results: Baseline demographic and laboratory parameters, including lipid profile and inflammatory markers, did not differ significantly between groups. However, patients with fQRS exhibited higher systolic and diastolic blood pressure, greater LVM and LVMI, and a markedly increased prevalence of LVH (60.9% vs. 14.6%). Carotid ultrasound revealed significantly higher CIMT values (Right: 0.87 vs. 0.71; Left: 0.86 vs. 0.70) and plaque burden (32.8% vs. 11%) in the fQRS group. Multivariable analysis identified right CIMT &gt;0.72 mm, left CIMT &gt;0.74 mm, LVM &gt;145 g, LVMI &gt;91 g/m², and carotid plaque presence as independent associates of fQRS. Conclusion: Fragmented QRS is strongly associated with both myocardial and vascular target-organ damage in hypertension. Its presence may serve as a non-invasive marker for identifying high-risk patients who warrant intensified cardiovascular risk assessment and management.

Autonomic-inflammatory crosstalk in diabetic atherogenesis: a neuroimmune triad (HRV-LMR-hsCRP) predicts carotid plaque risk in type 2 diabetes

The process of arterial atherosclerosis is characterised by accumulation of lipids and fibrous material with accompanying inflammation. As plaques progress, they restrict blood flow and cause rupture, which results in life threatening organ ischemia and dysfunction. Although extensively studied, a clear understanding of plaque heterogeneity and mechanisms that trigger their destabilization remains elusive. Our study reveals the molecular microarchitecture of human carotid artery plaques, using bulk and single-cell RNA sequencing combined with single-cell spatial transcriptomics, for which we present optimized cell segmentation algorithms. We identified distinct plaque morphologies linked to different cell type compositions, impacting early and advanced lesion formation, as well as destabilization. Spatial transcriptomics enabled us to further determine an inflammatory smooth muscle cell subtype, localize regions of neovascularization, and assign hotspots for macrophage activity within distinct cellular neighbourhoods across lesions. For different macrophage substates, we propose gradual and locally contained transdifferentiation of subluminal inflammatory HMOX1+ macrophages into a lipid-handling TREM2+ phenotype within border zones of the fibrous cap and necrotic core. Our findings provide insight into the complex heterogeneity of human atherosclerosis by unravelling location and proximity of different mural and immune cell substates involved in plaque progression and vulnerability.

The impact of carotid endarterectomy (CEA) on symptomatic patients with mild high-risk carotid stenosis has not been really investigated and it is not well-defined. This multicenter retrospective study aims to assess the safety and effectiveness of CEA in patients with 50% or less stenosis with symptoms despite best medical therapy. Between January 2018 and December 2024, all consecutive patients presenting with carotid-related neurological symptoms and a ≤50% high risk carotid stenosis submitted to CEA in eight high-volume vascular centers were included in the present study. All patients underwent duplex ultrasonography and computed tomography angiography to identify plaque morphological features. All patients were checked for alternative possible source of brain embolism. Twenty-nine patients with high-risk embolic plaques determining ≤50% stenosis and carotid-related neurological symptoms underwent CEA. The majority of plaques were Gray-Weale 1 or 2 (79.3%) and with ulcerated cap (79.3%). Symptoms reported at onset and during hospitalization up to CEA were 8 (27.5%) TIA, 8 (27.5%) crescendo TIA, 10 (34.4%) minor strokes, 3 (34.4%) strokes in evolution. Ischemic brain lesions of less of 25 mm were detected in 12 patients (41.3%). No perioperative stroke, death, myocardial infarction or cerebral hemorrhage occurred in this series. Only one TIA was detected due to a surgical defect that was promptly corrected. No patient experienced recurrent neurologic events related to the revascularized hemisphere during follow-up (mean 35.6 months). Despite the limited number of patients included in the study, CEA has been shown to be safe and effective in preventing recurrent neurological ischemic events in highly selected patients with mild carotid high-embolic-risk plaque stenosis treated at high-volume institutions. Further studies are required to identify the most appropriate diagnostic tools and the precise carotid plaque features associated with high-embolic risk.

TyG-ABSI as a novel metabolic obesity indicator for carotid plaque: an explainable machine learning study using SHAP in low-income population

Nonstenotic carotid artery plaque in patients with cryptogenic stroke after ICM: A sub-analysis of the LOOK study.

We aimed to identify the most valuable variables in multi-modal ultrasound technologies and compare the performance of radiomics models in detecting symptomatic carotid plaques. From August 2013 to April 2021, we retrospectively enrolled 112 carotid plaque patients and randomly divided them into training and validation cohorts at a 3:1 ratio. Additionally, 42 patients from two other centers were enrolled as an independent test cohort. A traditional model (T model) was built using independently significant variables from multivariate analysis of clinical and multi-modal ultrasound characteristics. Radiomics models based on B-mode ultrasound, contrast-enhanced ultrasound (CEUS), and a combined approach (USR, CEUSR, and US-CEUSR models) were then developed. Model performance was assessed using area under the receiver operating characteristic curve (AUC) and decision curve analysis. Only intraplaque contrast enhancement from CEUS modality was independently associated with clinical symptoms [odds ratio = 3.328; 95% confidence interval (CI), 1.230-9.003; p = 0.018] and was used to construct the T model, which achieved an AUC of 0.658 (95% CI, 0.502-0.815) in the external test cohort. The radiomics model showed good and repeatable diagnostic performance for identifying symptomatic plaques, particularly the US-CEUSR model, which had an AUC of 0.775 (95% CI, 0.607-0.915) in external test cohort. This model also provided high clinical benefits in detecting symptomatic plaques. Intraplaque contrast enhancement, a qualitative variable by CEUS, is an independent risk factor for symptomatic carotid plaques, and radiomics features from B-mode ultrasound and CEUS can effectively identify symptomatic carotid plaques.

BackgroundThe association between Metabolic Dysfunction–Associated Steatotic Liver Disease (MASLD) and the development of new carotid plaque in young adults requires further evidence from prospective studies.Methods In this study, young adults underwent abdominal and a carotid ultrasounds measurement were included. The carotid plaque progression was assessed in 2 years after baseline. MASLD is defined according to the liver ultrasound findings and self-reported alcohol consumption. Stepped adjusting multivariable logistic regression were employed to analyze the association between MASLD and the outcome. Subgroup analysis was conducted among sex and different amount of metabolic risk factors.ResultsA total of 36.54% (2411/6598) of all participants had MASLD at baseline. Among them, 626 (9.49%) participants were found new onset of carotid plaque in two years. Subjects who had progression of plaque had higher proportion of MASLD (53.99% vs 34.71%, SMD=0.396). Statistically significant positive associations were observed in unadjusted logistic regression models in overall or each sex, respectively. After fully adjustment, the association was only significant among female (OR:2.19, 95% CI: 1.28–3.72) and those had no metabolic risk factor (OR:1.67,95% CI:1.01–2.76). No significant associations were identified in all male subgroups, whereas the associations were still existing among female subgroups.ConclusionMASLD was found to be a risk factor of progression of carotid plaque among females and those who had not suffered from metabolic risk factor. Prevention should be focused on young adults who have MASLD at physical examination to reduce their risk of future atherosclerosis.