EXPRESS: A novel predictive model based on pericarotid adipose tissue and lumen stenosis for stroke risk in patients with asymptomatic carotid stenosis.

The study aimed to investigate the predictive value of clinical characteristics, major CTA indexes of carotid AS (carotid lumen stenosis and plaque burden) and inflammatory pericarotid adipose tissue for acute stroke risk in patients with a moderate or higher degree of carotid stenosis. One hundred and nineteen patients with unilateral carotid stenosis who underwent head and neck CT angiography were included and assigned to the stroke group or non-stroke group according to MRI. Pericarotid adipose tissue attenuation value, net enhancement value in the base phase and the enhancement phase, and atherosclerotic features (plaque burden and lumen stenosis) were recorded. Multivariate logistic regression analysis and the operating characteristic curve (ROC) were performed to establish a predictive model for the presence of acute ischemic stroke. ROC analysis showed that pericarotid adipose tissue attenuation value and lumen stenosis were predictive factors for stroke. The AUC of PCAT attenuation, lumen stenosis, the novel prediction model independently constructed based on PCAT attenuation and lumen stenosis resulted 0. 838 (95% CI 0. 759-0. 899), 0. 896 (95% CI 0.826-0.944), and 0. 942 (95% CI 0. 884-0. 977), respectively. The model had a sensitivity and specificity of 0. 909 and 0. 893 when the cutoff value was 0. 388. We found that the risk model combining pericarotid adipose tissue attenuation value and lumen stenosis has significant predictive values for the presence of symptomatic stroke among patients with moderate or higher degree of carotid stenosis.