{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:45:05Z","timestamp":1760060705484,"version":"build-2065373602"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,9,14]],"date-time":"2025-09-14T00:00:00Z","timestamp":1757808000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"JSPS KAKENHI","award":["25K10759"],"award-info":[{"award-number":["25K10759"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neurology International"],"abstract":"<jats:p>Objectives: While traditionally, carotid plaques with significant stenosis have been considered major embolic sources, recent evidence suggests that even non-stenotic small plaques with a &lt;50% stenosis rate may contribute to cerebral infarction. Herein, we evaluated the relationship between non-stenotic small plaques and embolic stroke of undetermined source (ESUS) using computed tomography angiography (CTA). Materials and Methods: We retrospectively reviewed our single-institutional database of hospitalized patients with stroke between April 2017 and December 2022 and enrolled them with ESUS. We evaluated the presence or absence of non-stenotic carotid artery plaque lesions ipsilateral and contralateral to the cerebral infarction lesion using CTA. A neurologist, blinded to the stroke side and all other clinical information, reviewed each CTA and viewed the axial and sagittal CTA source images. In each image, a line perpendicular to the vessel wall was drawn and the plaque diameter was measured. The largest part was considered as the maximum plaque diameter. Results: A total of 951 patients with stroke were hospitalized during the study period. Among these, 35 patients with unilateral anterior circulation ESUS were enrolled. Plaque prevalence &gt; 3 mm was compared between the carotid artery on the ESUS side and contralateral carotid artery. The prevalences were 31% and 8% on the ESUS and contralateral sides, respectively. Plaques &gt; 3 mm were often found on the ESUS side. Conclusions: Patients with ESUS were more likely to exhibit non-stenotic plaques of \u22653 mm in the infarcted carotid artery than in the contralateral carotid artery. Thus, small non-stenotic plaques may be the embolization source in ESUS, and CT angiography is useful for these evaluations.<\/jats:p>","DOI":"10.3390\/neurolint17090148","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T07:56:51Z","timestamp":1757923011000},"page":"148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Association Between Carotid Artery Small Plaque on Computed Tomography Angiography and Embolic Stroke of Undetermined Source"],"prefix":"10.3390","volume":"17","author":[{"given":"Junpei","family":"Nagasawa","sequence":"first","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatsuhiro","family":"Yokoyama","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makiko","family":"Ogawa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuichi","family":"Okamoto","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari","family":"Shibukawa","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junya","family":"Ebina","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takehisa","family":"Hirayama","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Osamu","family":"Kano","sequence":"additional","affiliation":[{"name":"Department of Neurology, Toho University Faculty of Medicine, Tokyo 143-8541, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1161\/STROKEAHA.116.016414","article-title":"Embolic Stroke of Undetermined Source: A Systematic Review and Clinical Update","volume":"48","author":"Hart","year":"2017","journal-title":"Stroke"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1161\/STROKEAHA.114.007240","article-title":"Embolic strokes of undetermined source in the Athens stroke registry: A descriptive analysis","volume":"46","author":"Ntaios","year":"2015","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/2396987316663049","article-title":"Rivaroxaban for secondary stroke prevention in patients with embolic strokes of undetermined source: Design of the NAVIGATE ESUS randomized trial","volume":"1","author":"Hart","year":"2016","journal-title":"Eur. 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