Carotid atherosclerotic plaque vulnerability assessment from angiography-derived radial wall strain validated by MRI

This study evaluates plaque stability in atherosclerotic carotid plaques, which are key stroke contributors, by using radial wall strain (RWS) from digital subtraction angiography (DSA). It explores the Link between RWS, symptomatic stenosis, and endovascular treatment outcomes. In a single-center prospective study, 82 patients undergoing endovascular carotid atherosclerotic stenosis (CAS) treatment were assessed. Plaque vulnerability was analyzed using high-resolution magnetic resonance angiography and RWS from DSA images, examining the consistency and correlation of these methods, determining the optimal RWS threshold, and its relation to ischemic symptoms. A statistically significant correlation (p < 0.001) and concordance (Kappa = 0.447, p < 0.001) were observed between RWSmax and various aspects of plaque stability, as evaluated using high-resolution nuclear magnetic resonance. In severe CAS, RWSmax was higher in damaged plaques (17.7% vs. 12.7%, p < 0.001), with a non-significant trend in moderate CAS (15.7% vs. 10.8%, p = 0.068). Symptomatic CAS patients had higher RWSmax in vulnerable plaques (18% vs. 10%, p < 0.001), with a similar non-significant difference in asymptomatic patients (16.9% vs. 13.1%; p = 0.051). The optimal RWSmax cutoff for identifying vulnerability was 14.9% (AUC = 0.838; p < 0.001; 85.5% sensitivity, 74.1% specificity). RWSmax demonstrated excellent diagnostic accuracy across subgroups. More symptomatic patients had vulnerable plaques than asymptomatic ones [85.71% vs. 39.39%, p < 0.001], with higher median RWSmax in symptomatic patients [17.40% vs. 14.80%, p = 0.008]. Significantly more symptomatic than asymptomatic patients had RWSmax values ≥ 14.9% (77.55% vs. 48.48%, p = 0.006). The DSA-based RWS is a valuable index for the evaluation of CAS plaque vulnerability.Trial Registration: The trial was registered to Chinese Clinical Trial Registry and the registration number is ChiCTR2400094665 (Registration date: 25/12/2024).