# Association between fibrinogen-to-albumin ratio and carotid intraplaque neovascularization on AngioPLUS in patients with asymptomatic carotid stenosis

## TL;DR

This study finds that a high fibrinogen-to-albumin ratio is linked to increased carotid plaque vulnerability in patients with asymptomatic stenosis.

## Contribution

The study introduces FAR as a novel biomarker for predicting carotid intraplaque neovascularization using AngioPLUS imaging.

## Key findings

- FAR was strongly associated with high IPN scores and IMVF grades after adjusting for confounding factors.
- A FAR cutoff of 7.578 effectively distinguished high from low IPN and IMVF groups.
- Elevated FAR levels correlated with increased plaque vulnerability in asymptomatic carotid stenosis patients.

## Abstract

•AngioPLUS is an innovative microvascular Doppler ultrasound technique for the evaluation of carotid IPN.•The IPN score is positively correlated with the IMVF grade on AngioPLUS.•FAR exhibits a strong association with both carotid IPN scores and IMVF grades.

AngioPLUS is an innovative microvascular Doppler ultrasound technique for the evaluation of carotid IPN.

The IPN score is positively correlated with the IMVF grade on AngioPLUS.

FAR exhibits a strong association with both carotid IPN scores and IMVF grades.

The importance of the Fibrinogen-to-Albumin Ratio (FAR) as a novel inflammatory and thrombotic biomarker in the development of carotid Intraplaque Neovascularization (IPN) is not well understood. This study aims to investigate the relationship between FAR and carotid IPN characteristics in patients with asymptomatic carotid stenosis.

We enrolled patients with carotid plaques for the AngioPLUS examination, and clinical and laboratory indicators were collected. Carotid IPN was evaluated by semi-quantitative visual grading of IPN and Intraplaque Microvascular Flow (IMVF). Binary logistic regression models were performed to determine potential associations between various variables and the presence of high IPN and IMVF.

In the study, a total of 187 patients were included, with 73 in the high IPN group and 98 in the high IMVF group. The IPN score was positively correlated with the IMVF grade, as indicated by a correlation coefficient of 0.815 (p < 0.001). A FAR value of 7.578 was the optimal cutoff value to differentiate high and low IPN as well as high and low IMVF. After adjusting for various factors, multivariate logistic regression models demonstrated that FAR was a strong predictor of the presence of high IPN and IMVF. Furthermore, a high FAR level was also significantly correlated with the presence of high IPN (OR = 2.81, 95 % CI 1.49‒3.30, p = 0.001) and high IMVF (OR = 2.55, 95 % CI 1.39‒4.68, p = 0.002) when the variable FAR grouping was included in the above models.

Elevated FAR is closely correlated with the presence of high IPN and IMVF on AngioPLUS and may facilitate plaque vulnerability.