Introduction

Atherosclerosis is a systemic disease, but the relationship between plaque characteristics in the coronary and carotid arteries remains unclear.

Aim

This study aimed to compare the morphological and compositional characteristics of atherosclerotic plaques in coronary and carotid arteries using multidetector computed tomography angiography (MDCTA) in the same patient group.

Material and methods

Eighty-eight patients who underwent both coronary and carotid MDCTA were analyzed. Plaque volume, composition (soft, mixed, calcified), and plaque burden were quantitatively measured in both vascular beds.

Results

Plaque burden (63.7% vs. 36.9%) and the proportion of soft plaque (23.5% vs. 7.2%) were significantly higher in the coronary arteries compared to the carotid arteries (p < 0.001 for both). Conversely, the total plaque volume and the proportion of calcified plaque were higher in the carotid arteries. While a strong positive correlation was found between the calcified plaque volumes in both vascular beds (r = 0.651, p < 0.001), importantly, no significant relationship was observed between the soft plaque volumes, which are associated with acute events (r = –0.037, p = 0.735).

Conclusions

Atherosclerosis exhibits different characteristics in the coronary and carotid arteries. While the accumulation of stable, calcified plaque reflects a systemic process, the formation of high-risk soft plaques appears to be more influenced by local factors. Therefore, although non-invasive assessment of the carotid arteries provides valuable information about the overall calcified atherosclerotic burden, it may be insufficient for predicting the presence of soft plaques in the coronary arteries and the associated risk of acute events.