Carotid Ultrasound Elastography for Atherosclerotic Plaque Assessment: Correlation with Clinical and Histological Findings

Background and Objectives: To investigate whether carotid artery elastography, including strain ratio and elasticity scores, can serve as an effective screening and diagnostic tool for carotid atherosclerosis and whether elastographic parameters correlate with histologic severity and clinical symptoms. Materials and Methods: This prospective study included consecutive patients undergoing endarterectomy for carotid artery disease in a single institution from January 2018 to December 2024 and assessed the association between ultrasound elastography parameters and histologically determined plaque severity using VEGF and COX-2 indices. Clinical correlations were also explored using demographic and symptomatic status data. Statistical methods included Spearman correlation, ROC analysis, and multivariate logistic regression. Results: In total 101 patients were included. No statistically significant correlations were observed between elastography measures and VEGF or COX-2 histologic indices. ROC analysis showed limited predictive value of elastographic markers (AUC range: 0.534 to 0.611). However, in multivariate analysis, plaque area was significantly associated with histologic severity as per the COX-2 index (OR = 0.14; 95% CI, 0.03-0.70; p=0.016). Symptomatic presentation was also associated with higher COX-2 levels (p=0.037). Conclusions: Carotid elastography demonstrates limited utility as an independent screening tool for histologic plaque severity. However, plaque morphology (area) may provide supportive value for identifying high-risk atherosclerotic lesions.