Carotid artery calcification score and its association with cognitive impairment

Figures & data

Table 1 Baseline characteristics of enrolled CAS patients and normal control group

	CAS (n=102)	Control (n=40)
Mean age (years)	61.5±10.2	57.5±9.7
Men	72 (70.6%)	26 (65%)
Systemic hypertension	85 (83.3%)	24 (60%)
Diabetes	43 (42.2%)	11 (27.5%)*
Smoking	66 (64.7%)	14 (33.3%)*
BMI	24.03±4.61	23.56±6.32
CS value	435.24±83.47	105.31±32.84*
Degree of stenosis	67.5%	13.3%*
Morphology index
LA	57.31±21.01	37.0±7.0*
WA	36.79±19.34	20.9±11.4*
TVA	94.1±34.15	57.9±14.3*
PB	0.42±0.46	0.01±0.07*
Histological index
LRNC	69 (67.6%)	0*
IPH	11 (10.7%)	0*
FCSR	3 (2.9%)	0*

Note:

* P<0.05.

Abbreviations: BMI, body mass index; CAS, carotid artery stenosis; CS, calcification score; FCSR, fibrous cap surface rupture; IPH, intraplaque hemorrhage; LA, lumen area; LRNC, lipid-rich necrotic nucleus; PB, plaque burden; TVA, total area of blood vessels; WA, wall area.

Figure 1 Linear relationship of ln(CS +1) with cognitive scores.

Notes: (A) Pearson correlation analysis of ln(CS +1) and cognitive score in CAS patient, R=−0.359, P<0.001; (B) Pearson correlation analysis of ln(CS +1) and cognitive score in postoperative patients with CEA, R=−0.079, P=0.091.
Abbreviations: CAS, carotid artery stenosis; CEA, carotid endarterectomy; CS, calcification score.

Figure 2 ANOVA of CS value.

Notes: (A) One-way ANOVA of CS value with different cognitive groups indicated that CS had significant differential expression in the 3 groups, P=0.019. *P=0.05; (B) ANOVA of CS value with different stenosis degree groups, P=0.097.
Abbreviation: CS, calcification score.

Table 2 Person correlation analysis of ln(CS +1) and stenosis degree, plaque burden morphological parameters (LA, WA, TVA and PB)

Parameter	Value	ln(CS +1)
		R	P-value
Degree of stenosis	0.65±0.82	0.161	0.057
LA	57.31±21.01	0.039	0.668
WA	36.79±19.34	0.521	0.042*
TVA	94.1±34.15	0.215	0.017*
PB	0.42±0.46	0.237	0.003*

Note:

* P<0.05.

Abbreviations: CS, calcification score; LA, lumen area; PB, plaque burden; TVA, the total area of blood vessels; WA, wall area.

Table 3 Chi-squared test of histological parameters of different CS groups

Feature	Mild CS (N=21)	Moderate CS (N=52)	Severe CS (N=29)	P-values
LRNC	12 (57.1%)	35 (67.3%)	24 (82.8%)	0.013*
IPH	3 (14.3%)	5 (9.6%)	3 (10.3%)	0.84
FCSR	1 (4.8%)	1 (1.9%)	1 (3.5%)	0.95

Notes: Discrete data are presented as counts and percentages;

* P<0.05.

Abbreviations: CS, calcification score; FCSR, fibrous cap surface rupture; IPH, intraplaque hemorrhage; LRNC, lipid-rich necrotic nucleus.

Figure 3 ROC curve of CS value’s prediction of carotid histological parameters.

Notes: (A) CS value’s prediction of IPH, P=0.156, AUC =0.658; (B) CS value’s prediction of LRNC, P=0.029, AUC =0.780; (C) CS value’s prediction of FCSR, P=0.729; AUC =0.051.
Abbreviations: AUC, area under the curve; CS, calcification score; FCSR, fibrous cap surface rupture; IPH, intraplaque hemorrhage; LRNC, lipid-rich necrotic nucleus; ROC, receiver operating characteristic.

Figure 4 Change in MMSE and MoCA pre- and post-CEA (X ± S).

Notes: (A) MoCA Post-CEA: P=0.042. (B) MoCA sub-tests: visuo-executive: P=0.026; Naming: P=0.029; Attention: P=0.032; Abstraction: P=0.017. (C) MMSE sub-tests: Recall: P=0.021. *P<0.05.
Abbreviations: CEA, carotid endarterectomy; MMSE, Mini–Mental State Examination; MoCA, Montreal Cognitive Assessment.

Figure S1 Carotid plaque calcium staining. Stained deposition of calcium presented as black annular, and plaque rupture occurred in the “right shoulder” of fibrous cap.

Table S1 Paired sample test results of the two physicians’ analysis

	Mean		N	SD	SE mean	t	df	P-value
Physician	A	345.2900	10	163.423	51.679	−0.088	9	0.932
	B	345.5600	10	165.036	52.189

Table S2 Baseline characteristics of left and right CAS patients

Parameter	Left-CAS (n=57)	Right-CAS (n=45)
Mean age (years)	60.7±8.21	62.5±5.7
Men	39 (68.1%)	34 (73.9%)
Systemic hypertension	48 (84.2%)	36 (80%)
Diabetes	24 (42.1%)	12 (26.6%)
Smoking	22 (39.6%)	21 (46.1%)
BMI	22.11±5.31	26.48±6.48
CS value	420.42±73.25	454.01±63.29
Degree of stenosis	68.5%	66.2%
Morphology index	58.51±26.03	55.79±21.15
LA	37.79±23.67	35.51±28.73
WA	96.3±36.71	91.3±32.81
TVA	0.41±0.83	0.43±0.92
PB
Histological index	38 (66.6%)	45 (68.9%)
LRNC	6 (10.5%)	5 (11.1%)
IPH	2 (3.5%)	1 (2.2%)

Note: No significant difference found.

Abbreviations: BMI, body mass index; CAS, carotid artery stenosis; CS, calcification score; IPH, intraplaque hemorrhage; LA, lumen area; LRNC, lipid-rich necrotic nucleus; PB, plaque burden; TVA, total area of blood vessels; WA, wall area.