{
  "abstract": "Background and AimsQuantifying arterial inflammation can augment risk stratification and drug development in atherosclerosis. While perivascular adipose tissue (PVAT) density, captured as fat attenuation index (FAI) on CT angiography (CTA), is an emerging biomarker of coronary inflammation, it remains unclear whether this concept extends to carotid atherosclerosis.\n\nMethodsUsing routine CTA data from hospital-based stroke cohorts, we developed a pipeline to quantify attenuation metrics of PVAT surrounding the distal common and proximal internal carotid arteries. We compared PVAT metrics between culprit and contralateral non-culprit plaques in patients with symptomatic carotid atherosclerosis and between culprit plaques and control carotid segments from patients without symptomatic atherosclerosis. In patients undergoing carotid endarterectomy, we assessed associations of CTA-derived PVAT metrics with histological and proteomic markers of plaque inflammation and stability.\n\nResultsAcross 107 patients with symptomatic carotid atherosclerosis (75.5{+/-}8.7 years; 63% men), PVAT attenuation metrics did not show significant differences between culprit and contralateral non-culprit lesions (all p>0.2). We also found no evidence for higher PVAT attenuation in culprit lesions, when compared to arteries of patients without symptomatic atherosclerosis. In 82 patients undergoing endarterectomy, pre-operative CTA-derived metrics of PVAT attenuation showed no significant correlations with CD68+ macrophage areas in excised plaques (r -0.11 to 0.07, all p>0.3). Similarly, no PVAT attenuation metrics were associated with thinner fibrous cap or higher plaque levels of pro-inflammatory cytokines (IL-6, TNF).\n\nConclusionsIn contrast to coronary atherosclerosis, carotid PVAT attenuation was not associated with symptomatic culprit lesions or histological and molecular markers of plaque inflammation and vulnerability.\n\nStructured Graphical AbstractO_ST_ABSKey QuestionC_ST_ABSCan perivascular adipose tissue (PVAT) attenuation on CT, proposed as a marker of coronary artery inflammation, also capture atherosclerotic plaque inflammation and vulnerability in the carotid arteries?\n\nKey FindingIn 107 patients with carotid atherosclerosis-associated stroke, PVAT attenuation did not differ between culprit and contralateral non-culprit lesions and was not associated with histopathological or molecular markers of plaque inflammation and vulnerability.\n\nTake-home MessagePVAT attenuation did not capture local carotid plaque inflammation or vulnerability in this cohort, questioning the transferability of this CT-based marker from coronary to carotid atherosclerosis.\n\nO_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=127 SRC=\"FIGDIR/small/26364115v1_ufig1.gif\" ALT=\"Figure 1\"> View larger version (33K): org.highwire.dtl.DTLVardef@704cf5org.highwire.dtl.DTLVardef@cc7f9eorg.highwire.dtl.DTLVardef@1ce5e7aorg.highwire.dtl.DTLVardef@19cd5f5_HPS_FORMAT_FIGEXP M_FIG C_FIG",
  "abstract_shown": true,
  "affiliations": [
    "Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "name": "S. Mayrhofer"
    },
    {
      "name": "L. Zivkovic"
    },
    {
      "name": "Y. Li"
    },
    {
      "name": "R. Batool"
    },
    {
      "name": "J. Louma"
    },
    {
      "name": "P. Reidler"
    },
    {
      "name": "A. Marei"
    },
    {
      "name": "N. Tsilimparis"
    },
    {
      "name": "DEMDAS study group"
    },
    {
      "affs": [
        0
      ],
      "name": "M. K. Georgakis"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/7f4bjxkxpjvk8.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.27.26364115",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.27.26364115v1.full",
  "id": "7f4bjxkxpjvk8",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.27.26364115v1",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ],
    [
      "openalex",
      "2705|Cardiovascular Disease and Adiposity"
    ]
  ],
  "openalex": "W7214787113",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.27.26364115v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-27",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/7f4bjxkxpjvk8.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:19:39Z",
      "native_id": "10.64898/2026.09.27.26364115",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.27.26364115v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Perivascular adipose tissue attenuation in CT angiography and plaque inflammation in patients with carotid atherosclerosis",
  "title_text": "Perivascular adipose tissue attenuation in CT angiography and plaque inflammation in patients with carotid atherosclerosis",
  "type": "preprint",
  "updated_at": "2026-10-30T12:19:39Z",
  "url": "https://research.draconitic.com/paper/7f4bjxkxpjvk8",
  "venue": "medRxiv",
  "versions": []
}