Prevalence and clinical implications of calcification in internal carotid artery stenosis: a retrospective study

• Published in: BMC neurology Vol. 24; no. 1; pp. 1 - 9
• Main Authors: Fu, Fengli, Liu, Xiaoli, Zhang, Rui, Zhang, Siran, Mao, Jianhua, Li, Yan, Wan, Shu, Xu, Shanhu
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 10.08.2024; BioMed Central; BMC
• Subjects: Analysis; Angiography; Arteries; Asymptomatic; Blood; Calcification; Cardiac arrhythmia; Cardiovascular disease; Carotid arteries; Carotid artery; Computed tomography; Coronary vessels; Diabetes; Feeding behavior; Flow velocity; Health aspects; Hypertension; Internal carotid artery; Ischemia; Ischemic stroke; Medical imaging; Multidetector computed tomographic angiography; Multivariate analysis; Patients; Plaque calcification; Positive rim sign; Prevention; Risk factors; Statistical analysis; Stenosis; Stroke; Stroke (Disease); Vein & artery diseases; Work stations; China; Germany
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-024-03788-9

Background Calcification is common in advanced atheromatous plaque, but its clinical significance remains unclear. This study aimed to assess the prevalence of plaque calcification in the moderate-to-severe internal carotid artery stenosis and investigate its relationship with ipsilateral ischemia. Methods The retrospective study included 178 patients detected with proximal internal carotid artery (pICA) stenosis of [greater than or equal to] 50% on multidetector computed tomography at Zhejiang Hospital from January 2019 to March 2023. Association between plaque calcification characteristics (calcification thickness, position, type, circumferential extent, calcium volume and calcium score) and ipsilateral cerebrovascular events was analyzed. Results The 178 patients (mean age 71.24 [+ or -] 10.02 years, 79.78% males) had 224 stenosed pICAs overall. Plaque calcification was noted in 200/224 (89.29%) arteries. Calcification rates were higher in older age-groups. Calcification volume (r = 0.219, p < 0.001) and calcification score (r = 0.230, p < 0.001) were correlated with age. Ipsilateral ischemic events were significantly more common in the noncalcification group than in the calcification group ([chl].sup.2 = 4.160, p = 0.041). The most common calcification type was positive rim sign calcification (87/200, 43.50%), followed by bulky calcification (66/200, 33.00%); both were significantly associated with ischemic events ([chl].sup.2 = 10.448, p = 0.001 and [chl].sup.2 = 4.552, p = 0.033, respectively). Calcification position, thickness, and circumferential extent, and calcification volume and score, were not associated with ischemic events. In multivariate analysis, positive rim signs (OR = 2.795, 95%CI 1.182-6.608, p = 0.019) was an independent predictor of ischemic events. Conclusions Plaque calcification in proximal internal carotid artery is common, and prevalence increases with age. Calcification characteristics could be predictive of ipsilateral ischemic events. The positive rim sign within plaque is a high-risk factor for a future ischemic event. Keywords: Internal carotid artery, Plaque calcification, Ischemic stroke, Positive rim sign, Multidetector computed tomographic angiography