Risk factors for co-existing extracranial carotid and intracranial artery high-risk atherosclerotic plaques in middle-aged and elderly patients: a Chinese atherosclerosis risk evaluation (CARE-II) study
Restricted accessResearch articleFirst published online 2026
Risk factors for co-existing extracranial carotid and intracranial artery high-risk atherosclerotic plaques in middle-aged and elderly patients: a Chinese atherosclerosis risk evaluation (CARE-II) study
Atherosclerosis is a systemic disease that usually affects multi-vascular beds, and high-risk atherosclerotic plaques (HRPs) are associated with ischemic events.
Purpose
To investigate the prevalence and risk factors of co-existing extracranial carotid and intracranial artery HRPs using magnetic resonance vessel wall imaging (MR-VWI).
Material and Methods
Participants (n = 190; 120 men, mean age = 63.4 ± 9.4 years) with co-existing extracranial carotid and intracranial plaques were recruited from a multicenter observational study of CARE-II. All patients underwent carotid MR-VWI and intracranial MRA at 3.0 T. The prevalence of risk factors between the non-HRP, single HRP, and co-existing HRPs groups was compared. Multivariate logistic regression analysis was used to determine the associations between risk factors and the three groups.
Results
Among 190 patients, 77 (40.5%) were in the non-HRP group, 78 (41.1%) were in the single HRP group, and 35 (18.4%) were in the co-existing HRPs groups. Multivariate regression analysis showed that patients in the co-existing HRPs group were more likely to have a higher prevalence of diabetes (OR = 3.92, 95% CI = 1.53–10.04; P = 0.004) and family history of cardiovascular disease (CVD) (OR = 3.37, 95% CI = 1.26–8.98; P = 0.015) compared to the non-HRP group after adjusting for age, sex, high-density lipoprotein (HDL), and smoking. Similarly, patients with co-existing HRPs were more likely to have higher prevalence of diabetes (OR = 2.49, 95% CI = 1.04–5.95; P = 0.040) compared to the single HRP group after adjusting for age, sex, and HDL.
Conclusion
Co-existing extracranial carotid and intracranial artery HRPs are observed in middle-aged and elderly symptomatic atherosclerotic patients. Diabetes and family history of CVD are independent risk factors for co-existing HRPs.
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