Abstract Body: Background and Objectives: Emerging literature suggests that non-stenotic carotid disease (<50% stenosis), especially in the presence of high-risk plaque features, can be a possible etiology for ischemic stroke. We aimed to evaluate the odds of concordant stroke among individuals with non-stenotic carotid arteries with various plaque features.
Methods: This is a secondary analysis from the Alteplase compared to Tenecteplase (AcT) trial. We evaluated carotid arteries on baseline CT Angiogram (CTA) to assess the degree of stenosis, plaque features such as ulceration, thickness, irregularity, hypodensity and presence of intraluminal thrombi, carotid web and dissection. 24hour follow-up imaging was used to evaluate stroke location. At a carotid level, we performed mixed effects logistic regression analysis adjusted for age and sex, with patient ID as a random effects variable, to determine the association between each high-risk plaque feature and the presence of concordant stroke (ipsilateral acute stroke in the territory of the carotid artery).
Results: Of 1577 patients in the trial, 1407 (89.2%) had interpretable baseline imaging.
Of these, 329 (23.4%) had no carotid disease, 869 (61.8%) had non-stenotic (<50%) carotid disease and 209 (14.9%) had stenotic (>50%) carotid disease. At a carotid level,
2519 (89.5%) had non-stenotic carotid disease. Of these, 689 (27.4%) had concordant stroke. Intraluminal thrombi and carotid webs were significantly associated with concordant stroke (aOR 8.11, 95% CI 1.6 – 41.08 and aOR 3.58, 95% CI 1.53 – 8.35, respectively). None of the other plaque features were significantly associated with concordant stroke.
Conclusions: Among patients with non-stenotic carotid disease, only the presence of intraluminal thrombi and carotid webs were found to be associated with increased odds of concordant stroke. Further CTA-based studies on larger populations are required to identify plaque features associated with concordant ischemic stroke.