{
  "abstract": "Objectives: To determine whether preoperative computed tomography quantification of low-attenuation plaque in the aortic arch improves perioperative cerebral infarction risk stratification beyond morphology-based atheroma grading.\n\nMethods: This single-centre retrospective cohort study included patients who underwent open or hybrid aortic arch repair with postoperative brain magnetic resonance imaging between January 2016 and December 2024. Preoperative computed tomography measured low-attenuation plaque area in the aortic arch (0-60 Hounsfield units) and arch atheroma grade. Low-attenuation plaque area was modelled as a continuous variable (per 10 mm2) in multivariable logistic regression with prespecified covariates, and discrimination was internally validated using 1000 bootstrap resamples. Receiver operating characteristic and decision tree analyses were performed only as exploratory descriptive analyses; restricted cubic spline modelling was used to assess potential non-linearity.\n\nResults: A total of 158 patients were analysed. New cerebral infarction lesions (NCILs) occurred in 84 patients (53.2%), including 15 symptomatic strokes (9.5%). Low-attenuation plaque area was independently associated with NCILs (adjusted odds ratio per 10 mm2, 1.69; 95% confidence interval, 1.34-2.22). Discrimination was acceptable (area under the curve, 0.82; 95% confidence interval, 0.75-0.88) with minimal optimism after bootstrap validation (optimism-corrected area under the curve, 0.79). In exploratory descriptive analyses stratified by atheroma grade and low-attenuation plaque (LAP) burden, NCIL incidence was substantially higher in higher-LAP strata within atheroma grades III (78.6% vs 25.0%) and IV (64.9% vs 25.0%).\n\nConclusions: Computed tomography–quantified low-attenuation plaque area in the aortic arch is independently associated with perioperative magnetic resonance imaging–detected cerebral infarction and may provide complementary information beyond morphology-based atheroma grading, while exploratory stratified analyses suggested heterogeneity in embolic vulnerability within intermediate atheroma grades.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 9,
  "authors": [
    {
      "name": "Fumio Yamana",
      "orcid": "0000-0002-8368-4166"
    },
    {
      "name": "Kazuo Shimamura",
      "orcid": "0000-0003-1481-0795"
    },
    {
      "name": "Ryoto Sakaniwa"
    },
    {
      "name": "Koichi Maeda"
    },
    {
      "name": "Yoshiki Watanabe"
    },
    {
      "name": "Takashi Shirakawa"
    },
    {
      "name": "Satoshi Sakakibara",
      "orcid": "0009-0001-9322-4235"
    },
    {
      "name": "Daisuke Yoshioka",
      "orcid": "0009-0004-4656-7317"
    },
    {
      "name": "Shigeru Miyagawa",
      "orcid": "0000-0003-0015-6569"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/1cknprvy7441e.bib",
  "cited_by": 0,
  "doi": "10.1093/icvts/ivag206",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13730588/",
  "id": "1cknprvy7441e",
  "issns": [
    "2753-670X"
  ],
  "landing_url": "https://doi.org/10.1093/icvts/ivag206",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "AcademicSubjects/MED00920"
    ],
    [
      "heading",
      "Eacts/161"
    ],
    [
      "heading",
      "Eacts/167"
    ],
    [
      "heading",
      "Original article"
    ],
    [
      "heading",
      "Vascular Disease"
    ],
    [
      "openalex",
      "2705|Cerebrovascular and Carotid Artery Diseases"
    ]
  ],
  "openalex": "W7214375953",
  "pdf_url": null,
  "pmcid": "PMC13730588",
  "pmid": "42786650",
  "published": "2026-09-24",
  "publisher": "Oxford University Press",
  "ris": "https://research.draconitic.com/paper/1cknprvy7441e.ris",
  "sources": [
    {
      "first_seen": "2026-11-07T12:23:06Z",
      "native_id": "PMC13730588",
      "source": "pmc",
      "url": "https://doi.org/10.1093/icvts/ivag206"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cerebrovascular and Carotid Artery Diseases",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Association of Computed Tomography–Quantified Low-Attenuation Plaque Area With Cerebral Infarction Beyond Morphology-Based Atheroma Grading in Aortic Arch Repair: A Retrospective Cohort Study",
  "title_text": "Association of Computed Tomography–Quantified Low-Attenuation Plaque Area With Cerebral Infarction Beyond Morphology-Based Atheroma Grading in Aortic Arch Repair: A Retrospective Cohort Study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-07T12:23:06Z",
  "url": "https://research.draconitic.com/paper/1cknprvy7441e",
  "venue": "Interdisciplinary Cardiovascular and Thoracic Surgery",
  "versions": []
}