Clinical and Carotid Plaque Features in Symptomatic and Asymptomatic Ischemic Stroke

<b>Aims/Background</b> Ischemic stroke (IS), a cerebrovascular condition, is commonly detected by evaluating carotid intima-media (CIA) stenosis. Symptomatic CIA stenosis carries a high risk (up to 32%) of another ischemic event within 12 weeks, while asymptomatic CIA stenosis has an annual risk ranging from 1% to 2%. Therefore, this study aims to explore the diagnostic value of clinical features and carotid plaque characteristics in both symptomatic and asymptomatic IS. <b>Methods</b> This study enrolled 543 consecutive patients with internal carotid artery stenosis confirmed by carotid ultrasonography. Participants were categorized into the symptomatic group (n = 356) and the asymptomatic group (n = 187) by clinical symptoms and computed tomography (CT)/magnetic resonance imaging (MRI) of the brain. Demographic data, clinical features, and ultrasonographic characteristics of the carotid plaque were collected, and logistics regression analysis was carried out to explore the predictive risk factors of IS. <b>Results</b> According to the differences in clinical and carotid plaque characteristics between the two groups, coronary heart disease (CHD), stenosis degree, plaque diameter, plaque length, plaque vulnerability, and plaque echo type were included. The results of the multivariate logistics regression analysis showed that plaque vulnerability, CHD, and plaque hypoechogenicity were independent predictors of symptomatic stroke. The clinical-ultrasonographic prediction model showed an area under the curve (AUC) of 0.85 [95% confidence interval (CI): 0.82-0.88], a sensitivity of 0.74 (95% CI: 0.69-0.78), and a specificity of 0.81 (95% CI: 0.76-0.87), with a good performance in the model prediction. <b>Conclusion</b> Plaque vulnerability, CHD, and plaque hypoechogenicity are meaningful predictors of symptomatic ischemic stroke and deserve attention in the future.