Introduction:

Non-stenotic carotid plaque is associated with embolic stroke of undetermined source (ESUS). This study characterizes the morphology of non-stenotic carotid plaque using head and neck CTA in Mexican patients with ipsilateral ESUS and in patients without ESUS but with other neurological diagnoses.

Material and methods:

This cross-sectional study was conducted in patients with non-stenotic carotid plaque (< 50%). Only unilateral evaluation of the carotid artery was reported using head and neck CTA. Patients with non-stenotic carotid plaque were classified into two groups: those with ipsilateral ESUS and those without ESUS but with other neurological diagnoses. The characteristics of non-stenotic carotid plaque considered high-risk for ischemic stroke, and those not considered high-risk, a history of ipsilateral ischemic stroke, and a transient ischemic attack (TIA) were recorded.

Results:

We included 410 patients with non-stenotic carotid plaque assessed by head and neck CTA: 175 (42.7%) with ipsilateral ESUS and 235 (57.3%) without ESUS but with other neurological diagnoses, including aneurysm, intracranial hemorrhage, demyelinating disease, or epilepsy. In the ipsilateral ESUS group, the most frequent high-risk characteristics of non-stenotic carotid plaque were irregular surface (n = 168, 96.0%) and ulceration (n = 102, 58.3%), whereas punctate calcifications (n = 131, 74.8%) and plaque length ≥ 10 mm (n = 111, 63.4%) were not considered high-risk. In the group without ESUS, an irregular surface was observed in 218 (92.8%) and ulceration in 131 (55.7%); punctate calcifications, identified in 164 (69.8%), and plaque length ≥ 10 mm in 159 (67.6%), were not considered high-risk. None of the morphological characteristics of non-stenotic carotid plaque showed a significant association with ipsilateral ESUS.

Conclusion:

In Mexican patients with ipsilateral ESUS, high-risk morphological characteristics of non-stenotic carotid plaque on head and neck CTA included an irregular surface, ulceration, a lipid-rich necrotic core, and intraplaque hemorrhage. Comparable results were found in patients without ESUS but with other neurological diagnoses.

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