Distinct Cross-Vascular Association Patterns of Carotid Plaque Burden and Vulnerability Features with Coronary Atherosclerotic Burden in Patients Undergoing Carotid Revascularization

Background/Objectives: This study aimed to investigate the associations between preoperative carotid high-resolution magnetic resonance imaging (HR-MRI) plaque features and coronary atherosclerotic burden, and to compare the cross-vascular association patterns of plaque burden-related measures and individual vulnerable plaque features.

Methods

This retrospective study included consecutive patients who underwent carotid revascularization and had both preoperative carotid HR-MRI and coronary computed tomography angiography (CTA) between April 2017 and December 2024. Carotid plaque characteristics included calcification, lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), loose matrix (LM), ulceration, maximum wall thickness (MWT), maximum wall area (MWA), and normalized wall index (NWI). Coronary atherosclerotic burden was characterized using coronary artery calcium score (CACS), maximum luminal stenosis, and the number of diseased coronary arteries; the number of coronary arteries with ≥50% stenosis was additionally recorded. Associations between carotid plaque characteristics and coronary atherosclerotic burden were evaluated using correlation analyses and multivariable logistic regression.