The report SC Advances in Atherosclerotic Disease: Imaging and Intervention 6 May 2026 Maastricht, Nederlands

This session on atherosclerosis and vascular mechanisms in stroke offered a comprehensive and clinically relevant overview of how atherosclerotic disease interact, shaping both stroke risk and recurrence. The presentations combined advanced imaging, biomarker research, and clinical data to refine our understanding of stroke aetiology and prevention.

Lucas Fache – Leuven, Belgium

Dr. Fache opened the session with an insightful presentation on intracranial artery calcification (IAC) and its clinical relevance. Using data from a large multicentre cohort, he demonstrated that IAC is highly prevalent, present in over 90% of patients with TIA or ischaemic stroke. Importantly, both the volume and morphology of calcifications were associated with stroke aetiology.

Patients with large-artery atherosclerosis showed higher calcification burden and more intimal-dominant patterns. Moreover, increasing IAC volume was linked to a higher prevalence of extracranial carotid stenosis and a significantly increased risk of recurrent stroke. These findings position IAC as a potential imaging biomarker for risk stratification and secondary prevention.

Haiwei Li – Guangzhou, China

Dr. Li presented real-world data on the effectiveness of immediate angioplasty or stenting in patients with acute ischaemic stroke due to severe intracranial atherosclerotic stenosis. The study addressed a clinically challenging subgroup where optimal management remains uncertain.

The findings suggested that early endovascular intervention may improve functional outcomes in selected patients, highlighting the importance of tailored treatment strategies in intracranial atherosclerosis. However, patient selection and procedural risks remain key considerations.

Fei Han – Beijing, China

Dr. Han explored the relationship between large artery phenotypes and cerebral small vessel disease (cSVD), focusing on vascular function. The study demonstrated that arterial abnormalities such as dolichoectasia and increased vessel diameter are associated with impaired cerebrovascular reactivity and altered blood–brain barrier permeability.

Importantly, reduced cerebrovascular reactivity partially mediated the progression of small vessel disease, suggesting that large artery pathology may act as a driver of downstream microvascular damage. This work highlights the interconnected nature of vascular pathology across different vessel sizes.

Elias Johansson – Gothenburg, Sweden

Dr. Johansson addressed stroke risk in patients with retinal artery occlusion (RAO) associated with symptomatic carotid stenosis. The analysis showed that patients presenting with retinal events (RAO or amaurosis fugax) have a lower risk of recurrent stroke compared to those with cerebral events.

Interestingly, the mechanism behind this lower risk remains unclear, despite evidence of embolic origin in RAO. These findings may have implications for risk stratification and timing of carotid interventions.

Gian Marco De Marchis – St. Gallen, Switzerland

Professor De Marchis presented interim results from the AGELESS study, focusing on lipid biomarkers and carotid plaque vulnerability. The data showed that LDL cholesterol and ApoB were strongly associated with symptomatic carotid disease and intraplaque haemorrhage, while lipoprotein(a) was not.

These findings suggest differential roles of lipid fractions in plaque instability and may inform more targeted preventive strategies in atherosclerotic stroke.

Anna Kopczak – Munich, Germany

Dr. Kopczak demonstrated the clinical utility of routine carotid MRI for detecting intraplaque haemorrhage (IPH). The study showed high interrater reliability across scanners and field strengths, supporting its feasibility in daily practice.

Importantly, the presence of IPH helped reclassify stroke aetiology in a subset of patients with previously cryptogenic stroke, reinforcing its value as a diagnostic and potentially prognostic marker.

Marc Delgado-Romeu – Barcelona, Spain

Dr. Delgado-Romeu focused on inflammation as a driver of plaque progression. Using FDG-PET imaging, the study showed that increased metabolic activity within carotid plaques was associated with a higher risk of progression and stroke.

Although based on interim data, these findings support the role of inflammation imaging as a tool for identifying high-risk plaques and guiding preventive strategies.

Juul Bierens – Maastricht, Netherlands

Dr. Bierens introduced spectral photon-counting CT, an emerging imaging technology that allows detailed characterisation of carotid plaque composition and stenosis.

This technique offers improved spatial resolution and tissue differentiation, with the potential to enhance detection of high-risk plaque features and refine patient selection for intervention.

Conclusion

This session highlighted the growing importance of integrated vascular imaging and biomarker-driven approaches in stroke care. From calcification and inflammation to plaque composition and vascular function, the studies emphasised that stroke is not a single-vessel disease but a complex, systemic process.

Advances in imaging and phenotyping are paving the way toward more precise risk stratification, personalised treatment, and improved prevention of recurrent stroke, underscoring the need for continued research and clinical integration.