Exploring the risk stratification of carotid plaque hemodynamic using four-dimensional blood flow technology

TL;DR

This study combines blood flow measurements and plaque structure to better predict the risk of carotid plaque rupture and stroke.

Contribution

The novel contribution is integrating downstream wall shear stress with structural biomarkers for improved cerebrovascular risk stratification.

Findings

Downstream wall shear stress (WSS) was significantly higher compared to upstream regions in carotid plaques.

Thin fibrous cap and normalized wall index independently predicted symptomatic plaques.

A combined model of structural and hemodynamic parameters achieved an AUC of 0.809 for predicting cerebral ischemic events.

Abstract

Carotid plaque rupture is a major cause of cerebrovascular events. This study explores the integration of hemodynamic parameters with structural biomarkers for improved risk stratification.

Fifty-seven patients with moderate-to-severe carotid stenosis underwent 4D-flow magnetic resonance imaging (MRI) and high-resolution MRI. Hemodynamic parameters [wall shear stress (WSS) and velocity] were analyzed using GT-Flow software at upstream, throat, and downstream plaque regions. After comparison of characteristic values between symptomatic and asymptomatic plaques, variables with p < 0.1 were included in the multivariate logistic regression model to identify independent risk factors.

WSS was significantly higher at plaque throat (0.891 ± 0.422 Pa) and downstream (0.971 ± 0.587 Pa) versus upstream (0.649 ± 0.297 Pa; p < 0.001). Symptomatic plaques showed elevated 3D-WSSmean (1.041 ± 0.418 vs. 0.797 ± 0.402 Pa, p = 0.032), WSS up_max (1.345 ± 0.570 vs. 0.970 ± 0.383 Pa, p = 0.004), and stenosis velocity (31.7 ± 9.9 vs. 25.8 ± 10.3 cm/s, p = 0.036). The thin fibrous cap (TFC, OR = 5.34, p = 0.007) and normalized wall index (NWI, adjusted OR = 59.89, p = 0.029) independently predicted symptomatic plaques. The combined model (NWI + TFC + WSS down_max) predicted cerebral ischemic events within 6 months with an AUC of 0.809 (95% CI: 0.699–0.919).

Integration of downstream hemodynamic profiling (WSS) with structural biomarkers (TFC and NWI) provides a robust stratification tool for cerebrovascular risk assessment. These quantitative parameters offer potential as molecular diagnostics for plaque vulnerability.

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