Impact of Carotid Artery Geometry and Clinical Risk Factors on Carotid Atherosclerotic Plaque Prevalence

<b>Objectives:</b> Carotid geometry and cardiovascular risk factors play a significant role in the development of carotid atherosclerotic plaques. This study aimed to investigate the correlation between carotid plaque formation and carotid artery geometry characteristics. <b>Methods:</b> A retrospective cross-sectional analysis was performed on 1227 patients, categorized into a normal group (n = 685) and carotid plaque groups causing either mild stenosis (<50% stenosis based on NASCET criteria, n = 385) or moderate-to-severe stenosis (>50%, n = 232). The left and right carotid were evaluated individually for each group. Patient data, including cardiovascular risk factors and laboratory test results, were collected. Carotid geometric measurements were obtained from 3D models reconstructed from cranio-cervical computed tomography angiography (CTA) using semi-automated software (MIMICS). The geometric variables analyzed included the vascular diameter and sectional area of the common carotid artery (CCA), internal carotid artery (ICA), external carotid artery (ECA), and carotid artery bifurcation (CAB), as well as the carotid bifurcation angles and carotid tortuosity. <b>Results:</b> Compared to the normal group, in both the right and left carotid arteries, patients with carotid plaques exhibited a significantly higher age (<i>p</i> < 0.001) and a greater prevalence of hypertension (<i>p</i> < 0.001) and diabetes mellitus (<i>p</i> < 0.001). Additionally, they demonstrated a larger CCA and a smaller carotid bifurcation dimension (<i>p</i> < 0.05). In the analysis of the left carotid artery, patients with carotid plaques also had a significantly smaller ICA dimension (<i>p</i> < 0.05) than the normal group. <b>Conclusions:</b> This study found that patients with carotid plaques were older and had a higher prevalence of hypertension and diabetes, larger CCAs, and smaller carotid bifurcations. The plaque-positive left ICA was significantly smaller than that of the plaque-negative group, suggesting a side-specific vulnerability. These findings highlight the role of carotid geometry in plaque formation and its potential clinical implications for personalized risk assessment and targeted interventions.