The association between carotid artery perivascular fat density and Covert brain infarction following carotid endarterectomy.

Covert brain infarction (CBI) is a common complication after carotid endarterectomy (CEA) and is associated with cognitive decline. Carotid artery perivascular fat density (PFD) reflects the severity of inflammation around the artery and is also related to plaque vulnerability. This study aimed to investigate the association between PFD and CBI in patients undergoing CEA. A total of 185 patients who underwent CEA were enrolled. PFD was measured using computed tomography angiography (CTA), and CBI was assessed on postoperative magnetic resonance imaging (MRI). Baseline characteristics, plaque features, and PFD were compared between patients with and without CBI. Logistic regression analysis was performed to evaluate the association between PFD and CBI, adjusting for confounding factors. Among 185 patients, 45 (24.3%) had CBI. Patients with CBI had significantly higher PFD (-41.46 ± 8.12 Hounsfield Units [HU]) compared to those without CBI (-59.95 ± 10.13 HU; P < 0.001). In logistic regression, PFD was associated with CBI (OR: 1.203, 95% CI: 1.139-1.271; P < 0.001). After adjustment in three models, this association remained significant independently. The optimal PFD cutoff for predicting CBI was - 51.7 Hu, with a sensitivity of 93.3% and specificity of 84.3%. Higher PFD was significantly associated with an increased risk of CBI following CEA. PFD may serve as a novel imaging marker for predicting CBI, aiding in preoperative risk assessment and patient management.