Association Of Cerebral Angiography And Optical Coherence Tomography Features With Symptomatic Carotid Stenosis

Purpose: This study aimed to investigate the association between plaque morphology revealed by digital subtraction angiography(DSA)and plaque features assessed by optical coherence tomography(OCT).This study also aimed to develop a scale combining clinical indicators,DSA,and OCT imaging markers to further understand the characteristics of symptomatic carotid stenosis.Methods: Patients with carotid stenosis ≥ 30% confirmed by DSA and underwent carotid OCT imaging in the department of neurology,Jinling hospital between June 2017 and June 2021 were retrospectively enrolled.Demographics,clinical characteristics,laboratory results,and followup data were collected.DSA and OCT images of the included patients were analyzed.Plaque surface morphology was classified as smooth and irregular according to the DSA.Plaque features were evaluated based on previously published consensus standards for OCT.Binary logistic regression was used to analyze the association between angiographic plaque surface irregularity and plaque characteristics assessed by OCT.Patients were separated into the symptomatic and the asymptomatic groups according to the presence or absence of previous symptoms.Symptomatic patients were defined as those who had a cerebral ischemic event,including ischemic stroke or transient ischemic attack,in the corresponding vascular territory within 6 months before the hospitalization.Logistic regression analysis was taken to generate the regression model on the dichotomous symptomatic carotid stenosis.β-coefficients from the regression model were used to generate the scoring system of the symptomatic scale.The optimal cut-off value of the scale was calculated using the receiver operating characteristics curve(ROC)analysis.The area under the ROC curve(AUC)was used to evaluate the overall performance of the model.Results: Of the 124 patients who underwent the carotid OCT examination,90 patients fulfilled the criteria and were enrolled in the study.The surface morphology of 33(36.7%)plaques was smooth and of 57(63.3%)plaques was irregular.Angiographic plaque irregularity was associated with lipid-rich plaque(OR,4.096;95% CI,1.250-13.423;P = 0.020)and plaque rupture(OR,15.862;95% CI,4.598-54.719;P < 0.001)assessed by OCT.Thirty-two patients(35.6%)were categorized as the symptomatic group and 58 patients(64.4%)as the asymptomatic group.Three main factors were found to be associated with symptomatic carotid stenosis: high-density lipoprotein cholesterol(HDL-C)<0.925 mmol/L(OR,4.708;95% CI,1.640-13.517;P = 0.004),irregular plaque(OR,4.017;95% CI,1.250-12.910;P = 0.020),and white thrombus(OR,4.594;95% CI,1.141-18.487;P = 0.032).The corresponding score of three items produced the scale with good discrimination(AUC,0.768;95% CI,0.665-0.871).The optimal cut-off value of the scale was 1.5 points with 59.4% sensitivity and 84.5% specificity.Conclusion: Angiographic plaque surface irregularity was associated with lipid-rich plaque and plaque rupture accessed by OCT.The three-item scale comprised of HDL-C <0.925 mmol/L,angiographical irregular plaque,and white thrombus detected by OCT may help to understand the difference between symptomatic and asymptomatic carotid stenosis.A combination of clinical indicators,cerebral angiography and OCT to assess carotid plaque can contribute to a comprehensive analysis of the risk of plaque and an understanding of the association between plaque vulnerability and clinical presentation.