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
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.
Methods: 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.
Results: 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%).
Conclusions: 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.
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BibTeX
@article{yamana2026association,
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}},
author = {Fumio Yamana and Kazuo Shimamura and Ryoto Sakaniwa and Koichi Maeda and Yoshiki Watanabe and Takashi Shirakawa and Satoshi Sakakibara and Daisuke Yoshioka and Shigeru Miyagawa},
journal = {Interdisciplinary Cardiovascular and Thoracic Surgery},
year = {2026},
month = sep,
doi = {10.1093/icvts/ivag206},
url = {https://doi.org/10.1093/icvts/ivag206},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Fumio Yamana
AU - Kazuo Shimamura
AU - Ryoto Sakaniwa
AU - Koichi Maeda
AU - Yoshiki Watanabe
AU - Takashi Shirakawa
AU - Satoshi Sakakibara
AU - Daisuke Yoshioka
AU - Shigeru Miyagawa
PY - 2026
DA - 2026/09/24
JO - Interdisciplinary Cardiovascular and Thoracic Surgery
DO - 10.1093/icvts/ivag206
UR - https://doi.org/10.1093/icvts/ivag206
AB - 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. Methods: 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. Results: 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%). Conclusions: 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.
SN - 2753-670X
ER -