CAROTID plaque evolution is a critical factor in understanding stroke risk and vascular health. A recent study investigated the progression of subclinical carotid plaques by investigating how existing plaque compositions influence the development of new components within the same plaque. Notably, this study identified that plaques containing calcification are significantly more likely to develop intraplaque haemorrhage (IPH), a marker of plaque vulnerability, highlighting an important pathway in plaque progression that has not been widely explored.
The prospective study was conducted within the Rotterdam Study cohort, including 802 participants aged 45 and over with carotid intima-media thickness exceeding 2.5 mm. Each participant underwent two MRI scans of the carotid arteries, one at baseline and another after six years, using the same scanner to ensure consistency. Radiologists assessed plaque components such as calcification, IPH, and lipid-rich necrotic cores. Statistical analyses employed generalised estimating equations to model the relationship between baseline plaque compositions and the appearance of new components, adjusting for confounding variables. Age-specific probabilities of plaque evolution were calculated, and a 30-year simulation of plaque progression was performed using the Chapman–Kolmogorov equation.
Results demonstrated that plaques with existing calcification had twice the odds of developing IPH compared with those without calcification (adjusted odds ratio 2.00; 95% CI: 1.26–3.16; p=0.003). Over time, multicomponent plaques increased notably from 10% prevalence at age 55 to over 50% after age 70. Additionally, men were significantly more likely than women to progress from no or single-component plaques to multicomponent plaques containing IPH (21% versus 13%, p<0.001). Only a small fraction of plaques (2.9%) exhibited significant carotid stenosis, indicating that plaque composition changes precede severe narrowing.
In conclusion, the findings suggest that the presence of calcification in subclinical carotid plaques is a key predictor of IPH development and that plaque complexity increases substantially with age, particularly among men. These insights have clinical implications for identifying individuals at higher risk of plaque rupture and subsequent cerebrovascular events, potentially informing surveillance and management strategies. Limitations include the observational design, which cannot establish causality, and the use of MRI which may have detection thresholds. Further research is needed to explore interventions that might modify plaque progression and improve clinical outcomes.
Reference
Zuo L et al. Evolution of Subclinical Carotid Atherosclerotic Plaque Composition Using Serial MRI in the Rotterdam Study. Radiology. 2025;DOI: 10.1148/radiol.242248.
