Carotid Intraplaque Neovascularization Increases the Risk of Recurrent Anterior Circulation Ischemic Stroke: A Prospective Cohort Study

Background and purpose The prognostic value of intraplaque neovascularization (IPN) in carotid artery plaques for predicting recurrent anterior circulation ischemic stroke (ACIS) remains uncertain. This study aimed to evaluate whether IPN can predict recurrent stroke in patients with ACIS and to determine whether the integration of IPN with conventional risk factors enhances risk stratification. Methods We prospectively enrolled consecutive patients with acute cerebral infarction syndrome (ACIS) who underwent assessment of intraplaque neovascularization (IPN) using AngioPLUS, an ultrasound-based imaging modality, between August 2020 and February 2025. A Cox proportional hazards regression model was employed to identify independent predictors of recurrent ischemic stroke. The predictive performance of a novel model incorporating IPN was compared with that of a conventional model excluding IPN by calculating the time-dependent area under the receiver operating characteristic curve (AUC). Results A total of 143 patients were included in the analysis, comprising 93 men and 50 women, with a mean age of 67.6 ± 11.7 years. The follow-up period ranged from 6 to 56 months, with a median duration of 21 months. Recurrent ischemic stroke occurred in 26 patients. Intergroup comparisons revealed significantly higher levels of fasting blood glucose (P = 0.012), homocysteine (P = 0.018), and a greater proportion of patients with grade 2 IPN (P = 0.002) in the recurrence group compared to the non-recurrence group. Multivariate Cox regression analysis identified grade 2 IPN as an independent predictor of recurrent ischemic stroke (HR = 6.936; 95% CI, 2.464–19.524; P < 0.001). Time-dependent receiver operating characteristic analysis showed that adding carotid IPN to the conventional model significantly improved its predictive accuracy for recurrent ACIS at 24, 36, and 48 months (all P < 0.05). Conclusion Carotid IPN is an independent predictor of recurrent ACIS. Incorporating IPN assessment with conventional risk factors improves the identification of high-risk patients.