# Extracranial carotid plaque calcification and its association with risk factors for cerebrovascular events: insights from the ANTIQUE study

## TL;DR

This study examines how different types of carotid plaque calcification relate to stroke risk and other health conditions in patients with carotid artery narrowing.

## Contribution

The study identifies distinct associations between spotty and large calcifications and specific risk factors like age, sex, and heart disease.

## Key findings

- Spotty calcifications are linked to male sex and smoking, while large calcifications are associated with older age and coronary heart disease.
- Large calcifications are strongly connected to atrial fibrillation and contralateral stenosis.
- No significant relationship was found between calcification types and cerebrovascular events.

## Abstract

Extracranial carotid calcification is a common marker of advanced atherosclerosis. However, its impact on stroke risk is not consistent across studies, and examining the type of calcification and the presence of systemic diseases might be helpful. We aimed to investigate extracranial carotid calcification and its association with risk factors for ischemic cerebrovascular diseases.

Among 1,863 consecutive patients in the Atherosclerotic Plaque Characteristics Associated with a Progression Rate of the Plaque and a Risk of Stroke in Patients with the Carotid Bifurcation Plaque Study (ANTIQUE), 132 symptomatic or asymptomatic patients (177 carotid plaques) with >30% carotid stenosis examined through computed tomography (CT) and magnetic resonance imaging (MRI) were included. Statistical data were assessed using the χ2-test, Fisher’s exact test, t-test, and Mann–Whitney test to investigate the calcification risk factors.

Compared to the absence of calcifications, spotty calcifications were associated with male sex [odds ratio (OR): 3.72, 95% confidence interval (CI): 1.06–13.05], while large calcifications were associated with older patients (OR: 1.60 per 5 years of age, 95% CI: 1.20–2.13). Large calcifications were also strongly associated with coronary heart disease (OR: 4.07, 95% CI: 1.15–14.44) and atrial fibrillation (p = 0.025). In comparison between only spotty and large calcifications, spotty calcifications were associated with male sex (OR: 3.72, 95% CI: 1.06–13.05), smoking (p = 0.020) in more significant quantities (p = 0.014), and lipid plaque (p < 0.001), while large calcifications with contralateral stenosis degree (p = 0.044). No significant relationship was found between cerebrovascular events and the type of calcification.

Although the presence and type of extracranial carotid calcification were not related to ipsilateral ischemic events, large calcifications were strongly associated with coronary heart disease and atrial fibrillation.

ClinicalTrials.gov, identifier NCT02360137.