Evidence map›Paper›PMID 42550799›Full record

ArticleCerebrovascular diseases extra2026

Beyond Stenosis: Prevalence and the Characteristics of Nonstenotic Carotid Plaques in Embolic Stroke of Undetermined Source.

Manuraj Natarajan, Adarsh Anil Kumar, Asish Vijayaraghavan, Santhosh Kannoth, Sapna Erat Sreedharan, Arya Devi Karuthedathu Mana Sanal Kumar, Padmavathy Narayanan Sylaja

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Article in Cerebrovascular diseases extra, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Manuraj NatarajanComprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Adarsh Anil KumarDepartment of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Asish VijayaraghavanDepartment of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Santhosh KannothDepartment of Imaging Science and Interventional Radiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Sapna Erat SreedharanComprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Arya Devi Karuthedathu Mana Sanal KumarComprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Padmavathy Narayanan SylajaComprehensive Stroke Care Program, Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India, sylajapn@hotmail.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionNonstenotic carotid plaques, despite being considered low risk for stroke, are increasingly recognized to contribute to embolic strokes of undetermined source (ESUS). Emerging evidence indicates that rather than the degree of stenosis, high-risk plaque characteristics like plaque irregularity and intraplaque hemorrhage may increase the embolic risk. We analyzed the prevalence and characteristics of nonstenotic carotid plaques in ESUS and their implications for stroke recurrence risk.

methodsWe retrospectively identified 274 patients with ESUS between 2012 and 2022. The computed tomography angiograms were analyzed for nonstenotic carotid plaques (<50% stenosis, as per NASCET criteria) by blinded neuroradiologists. The infarct patterns and plaque characteristics were evaluated. The stroke recurrences at 3 months and 1 year were noted.

resultsThe mean age of the study population was 57.99 ± 12.86 years, and 65.3% were males. The nonstenotic plaques (30-50% stenosis) were more common on the symptomatic side of stroke (13.3% vs. 7.3%, p = 0.026). Plaques with irregularity were also more frequent on the symptomatic side (16.4% vs. 9.7%, p = 0.023). Patients with symptomatic nonstenotic plaques had a higher incidence of embolic (25% vs. 5%, p = 0.000) and watershed infarcts (16.7% vs. 4.6%, p = 0.005). The stroke recurrence risk and mortality at 3 months and 1 year did not differ between the 2 groups.

conclusionIn this single-center retrospective study, nonstenotic carotid plaques with 30-50% stenosis were more prevalent on the symptomatic side, suggesting a potential role in stroke mechanism. The higher rates of embolic and watershed infarcts and the presence of plaque irregularity on the symptomatic side support this association.

Indexed as

Carotid Artery DiseasesCarotid StenosisEmbolic StrokePlaque, AtheroscleroticAdultAgedComputed Tomography AngiographyFemaleHumansMaleMiddle AgedPrevalencePrognosisRecurrenceRetrospective StudiesRisk AssessmentCarotid stenosisEmbolic stroke of undetermined sourceNonstenotic carotid plaques

Identifiers

PMID42550799
PMCPMC13685590

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