Quantitative CTA-Based Carotid Plaque Composition Across Stroke Etiologies and Residual Vascular Risk

In 314 patients with acute ischemic stroke or TIA of undetermined etiology, ipsilateral carotid plaques show greater LRNC volume (ratio 1.97; 95% CI, 1.22–3.18).

• Why it matters: Luminal stenosis alone may miss plaque vulnerability, and the prognostic value of quantitative CTA plaque composition—especially for undetermined etiology—remains unclear.
• What they did: Quantitative plaque composition was measured on routine CTA using commercially available software, comparing ipsilateral versus contralateral plaques across etiologic groups and testing links to later vascular events with Cox regression.
• The result: Over a median 3-year follow-up, larger LRNC volume predicted subsequent vascular events in undetermined-etiology ischemic stroke (HR 1.96; 95% CI, 1.12–3.43), supporting CTA-based LRNC as residual vascular risk information.

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