J Neurosonol Neuroimag.  2025 Jun;17(1):11-19. 10.31728/jnn.2025.00169.

High-risk features of carotid sonography predicting cardiovascular events among the stroke patients with atrial fibrillation

• Lee SJ
• Lee TK
• Moon JE

• KMID: 2569347
• DOI: http://doi.org/10.31728/jnn.2025.00169

Abstract

Background
We aimed to determine whether carotid and vertebral duplex sonography can predict adverse outcomes in stroke patients with atrial fibrillation (AF).
Methods
A total of 207 stroke patients with AF were analyzed. The key metrics included the carotid plaque score (CPS, 0–24), mean carotid intima-media thickness (cIMT), and high-risk features of sonography (HRFS). HRFS were defined as the presence of ulcerative, irregular, heterogeneous, or hypoechoic plaques; >50% carotid steno-occlusion; or abnormal Doppler spectra in the V2 vertebral artery segment. Predictors of future vascular events and major adverse cardiovascular events (MACEs) were identified using Cox regression, with adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) calculated. The integrated time-dependent area under the curve for HRFS, CHA2DS2-VASc score, mean cIMT, and CPS was also assessed.
Results
HRFS (aHR 4.86, 95% CI 1.41–16.77) were independently associated with future vascular events. Age (aHR 1.06, 95% CI 1.02–1.11), chronic kidney disease (aHR 2.03, 95% CI 1.00–4.12), admission National Institutes of Health stroke scale (aHR 1.04, 95% CI 1.00–1.08), and HRFS (aHR 2.45, 95% CI 1.18–5.08) were independently associated with MACE. Adverse outcomes were significantly more frequent in patients with HRFS (p<0.001, log-rank test). HRFS demonstrated a significantly better discriminatory ability than mean cIMT in predicting outcomes.
Conclusion
Duplex ultrasonography of the carotid and vertebral arteries is crucial for predicting MACE in stroke patients with AF. HRFS, rather than CPS or mean cIMT, may be a better marker for predicting MACE in this population.

Keyword

carotid ultrasonography; Doppler; vertebral artery; stroke; atrial fibrillation