Association of carotid atherosclerosis, perivascular adipose tissue, and stiffness by ultrasound assessment in young adults with ischemic stroke

In the last decade, the incidence of stroke among young adults has risen globally. The relevance of carotid intima-media thickness (IMT) and plaque in predicting ischemic stroke (IS) in this population remains uncertain. This study investigated the relationship between ultrasound-evaluated carotid wall properties and occurrence and severity of IS in young adults. Young adults (n = 147) aged 18-50 years with IS and 294 age- and sex-matched controls were included. Ultrasound-assessed variables included carotid atherosclerosis, perivascular adipose tissue, and arterial stiffness. Ultrasound parameters included IMT, plaque presence, extra-media thickness (EMT), and flow augmentation index (FAI). Multivariate and ROC curve analyses were conducted. All ultrasound parameters were elevated in the IS group. Carotid EMT and FAI were associated with IS, while IMT and plaque were not. The multivariate model combining carotid EMT and FAI showed a superior area under the curve compared to models incorporating either parameter alone. Plaque presence and increased EMT thickness correlated with higher scores on the National Institutes of Health Stroke Scale. Carotid EMT and FAI are independent vascular risk factors for IS in young adults. The potential of EMT and plaque presence as biomarkers for assessing disease severity warrants further investigation.