Carotid intraplaque neovascularization for predicting ischemic cerebrovascular events in patients with hypertension.

Background: Patients with hypertension are prone to developing carotid atherosclerotic plaques, and unstable plaques are a key contributor to ischemic cerebrovascular events (ICEs), including transient ischemic attacks (TIAs) and ischemic strokes. Intraplaque neovascularization (IPN), the formation of microvessels within plaques, is a recognized marker of plaque vulnerability. This study aimed to evaluate the association between IPN in carotid plaques and the risk of ICEs in older adult patients with hypertension. Methods: This retrospective cohort study included 438 patients with hypertension aged ≥60 years. Carotid plaques were assessed with superb microvascular imaging (SMI), and IPN was graded from 0 (none) to 3 (severe). Patients were followed up for 3 years to track the incidence of ICEs. Logistic regression models were used to analyze the association between IPN grade and ICE risk, with adjustments made for demographic and cardiovascular risk factors. Results: Among the 314 patients with carotid plaques, 113 (36.0%) experienced ICEs during follow-up. The incidence of ICEs increased progressively with IPN severity: 15.2% for grade 0, 37.3% for grade 1, 50.5% for grade 2, and 51.2% for grade 3. Compared to that in patients with IPN grade 0, the odds of ICEs were significantly higher in patients with IPN grade 2 [odds ratio (OR) =3.73; P<0.01] and grade 3 (OR =5.14; P<0.01). IPN grade >1 was significantly associated with increased ICE risk (P<0.05). After adjustments were made for age, sex, smoking, diabetes, and hyperlipidemia, IPN remained an independent predictor of ICEs [adjusted OR =1.87; 95% confidence interval (CI): 1.12-3.14; P=0.03]. Conclusions: Carotid IPN, as assessed by SMI, is independently associated with an elevated risk of ICEs in older adult patients with hypertension. IPN grading may serve as a useful and noninvasive marker for cerebrovascular risk stratification in this population.