SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Carotid Stenosis and CT: Scoping Review with ☸️SAIMSARA.

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Vascular Health

Issue 1, Volume 1, 2026

Editorial note
• Last update: 2026-03-20 13:06:19
What is this paper about
This paper shows that CT angiography in carotid stenosis is not just about measuring narrowing: it can reveal plaque vulnerability, near-occlusion, carotid webs, and hidden stroke risk that standard stenosis thresholds may miss. It is worth reading because it maps where CT truly adds clinical value, where it can mislead, and how more structured CTA reporting could change decision-making.

DOI: 10.62487/saimsara5b51e772

Abstract: This paper aims to comprehensively review the applications of computed tomography in the diagnosis, characterization, and risk stratification of carotid stenosis, as well as its utility in guiding therapeutic interventions and predicting clinical outcomes. The review utilises 232 original studies with 56443 total participants (topic deduplicated ΣN). Across the mapped evidence, CTA-based assessment of carotid disease consistently extends beyond luminal narrowing, with multiple plaque-level features aligning with symptomatic status and downstream risk; for example, CTA detected plaque ulceration with 94% sensitivity and 99% specificity versus surgical specimens. At the same time, stenosis quantification on CTA can be systematically biased in certain settings—area-based calculations may overestimate severity relative to NASCET diameter methods, and semiautomated approaches showed high specificity (96%) but lower sensitivity (63%) in the presence of calcification—highlighting the need to interpret “percent stenosis” in context. The evidence map also indicates convergent signals that vulnerability phenotypes (e.g., soft plaque thickness, intraluminal thrombus, calcification patterns, perivascular fat density, and radiomics signatures) are associated with symptoms and future events, including in mild or non-stenotic disease where stroke mechanisms may be missed by stenosis thresholds alone. Clinically, these findings support more structured CTA reporting that integrates stenosis with high-risk plaque descriptors to inform triage, procedural planning, and follow-up decisions. Future research should prioritize prospective, standardized, multi-center validation of CT plaque metrics (including AI/radiomics) against clinically meaningful outcomes and consistent reference standards, particularly for near-occlusion and non-stenotic phenotypes.
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Keywords: Carotid Stenosis; CT Angiography; Carotid Plaque; Ischemic Stroke; Plaque Characterization; Near-occlusion; Radiomics; Transient Ischemic Attack; Hemodynamics; Diagnostic Accuracy

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