Association between fibrinogen-to-albumin ratio and carotid intraplaque neovascularization on AngioPLUS in patients with asymptomatic carotid stenosis

Jun He; Jimei Xu; Shugang Cao; Yuan Feng; Jian Wang; Yan Yan; Fang Ma; Mingwu Xia; Qingsong Wang

doi:10.1016/j.clinsp.2025.100710

Association between fibrinogen-to-albumin ratio and carotid intraplaque neovascularization on AngioPLUS in patients with asymptomatic carotid stenosis

Clinics (Sao Paulo). 2025 Jul 9:80:100710. doi: 10.1016/j.clinsp.2025.100710. Online ahead of print.

Authors

Jun He¹, Jimei Xu², Shugang Cao³, Yuan Feng³, Jian Wang³, Yan Yan³, Fang Ma², Mingwu Xia³, Qingsong Wang⁴

Affiliations

¹ Department of Neurology, PLA Clinical College of Anhui Medical University, The 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei 230001, PR China; The Fifth Clinical Medical College of Anhui Medical University, Hefei 230001, PR China; Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei 230001, PR China.
² Department of Ultrasound, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei 230001, PR China.
³ Department of Neurology, Hefei Hospital Affiliated to Anhui Medical University, The Second People's Hospital of Hefei, Hefei 230001, PR China.
⁴ Department of Neurology, PLA Clinical College of Anhui Medical University, The 901st Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army, Hefei 230001, PR China; The Fifth Clinical Medical College of Anhui Medical University, Hefei 230001, PR China. Electronic address: wangqingsong68@hotmail.com.

PMID: 40639300
DOI: 10.1016/j.clinsp.2025.100710

Abstract

Introduction: The importance of the Fibrinogen-to-Albumin Ratio (FAR) as a novel inflammatory and thrombotic biomarker in the development of carotid Intraplaque Neovascularization (IPN) is not well understood. This study aims to investigate the relationship between FAR and carotid IPN characteristics in patients with asymptomatic carotid stenosis.

Methods: We enrolled patients with carotid plaques for the AngioPLUS examination, and clinical and laboratory indicators were collected. Carotid IPN was evaluated by semi-quantitative visual grading of IPN and Intraplaque Microvascular Flow (IMVF). Binary logistic regression models were performed to determine potential associations between various variables and the presence of high IPN and IMVF.

Results: In the study, a total of 187 patients were included, with 73 in the high IPN group and 98 in the high IMVF group. The IPN score was positively correlated with the IMVF grade, as indicated by a correlation coefficient of 0.815 (p < 0.001). A FAR value of 7.578 was the optimal cutoff value to differentiate high and low IPN as well as high and low IMVF. After adjusting for various factors, multivariate logistic regression models demonstrated that FAR was a strong predictor of the presence of high IPN and IMVF. Furthermore, a high FAR level was also significantly correlated with the presence of high IPN (OR = 2.81, 95 % CI 1.49‒3.30, p = 0.001) and high IMVF (OR = 2.55, 95 % CI 1.39‒4.68, p = 0.002) when the variable FAR grouping was included in the above models.

Conclusion: Elevated FAR is closely correlated with the presence of high IPN and IMVF on AngioPLUS and may facilitate plaque vulnerability.

Keywords: Angio planewave ultrasensitive imaging; Carotid plaque; Fibrinogen-to-albumin ratio; Intraplaque neovascularization.