Carotid topography and glucemic load in the segmental expression of atherosclerotic plaque in ischemic stroke

Background: Treating carotid plaque as a single lesion may obscure anatomical and glycemic variations across different vascular territories. objective: To analyze whether carotid topographic differences and chronic glycemic exposure measured by HbA1c are associated with the segmental expression of plaque in ischemic stroke. Method: Analytical study based on a secondary dataset of 21,459 patients with ischemic stroke. The presence of plaque in the common, internal, and external carotid arteries was modeled as independent segmental outcomes using binary logistic regression. Model performance was evaluated through overall fit (Omnibus χ² test), calibration (Hosmer-Lemeshow test), explained variance (Cox & Snell and Nagelkerke R^2), and discrimination (ROC curves with paired bootstrap comparison of AUCs). An HbA1c × territory interaction term was included to explore glycemic heterogeneity across vascular segments. results: Age and sex were associated with plaque across all carotid segments, whereas uremia showed a stronger effect in the internal carotid artery (OR: 2.37; 95% CI: 1.23-4.58). HbA1c exhibited an ascending gradient from the common carotid artery (OR: 1.19) to the external carotid artery (OR: 1.55; p < 0.001).The HbA1c × territory interaction was significant, indicating a localized pattern associated with glycemic exposure. conclusion: In ischemic stroke, the topographic-glycemic variability of carotid plaque suggests the presence of segmental atherosclerotic phenotypes influenced by sustained glycemic exposure.