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Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source

Jae W Song1, Huy Q Phi2, Manisha Koneru3

  • 1Departments of Radiology (J.W.S., Y.S., J.H.W.), University of Pennsylvania, PA.

Stroke
|January 24, 2025
PubMed

Insights

High-risk carotid plaque subtypes, identified using a modified computed tomography angiography (CTA)-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification, were more prevalent on the stroke side in patients with embolic stroke of undetermined source.

Area of Science:

  • Neurology
  • Radiology
  • Cardiovascular Science

Background:

  • Embolic stroke of undetermined source (ESUS) poses a diagnostic challenge.
  • Carotid plaque characteristics are implicated in stroke etiology.
  • Computed tomography angiography (CTA) is widely used for stroke evaluation.

Purpose of the Study:

  • To evaluate the prevalence of high-risk carotid plaque subtypes on the stroke side in ESUS patients.
  • To assess the utility of a modified CTA-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification.
  • To determine if high-risk Plaque-RADS subtypes are more common ipsilateral to the stroke.

Main Methods:

  • Retrospective observational study of 94 ESUS patients with unilateral anterior circulation stroke and <50% carotid stenosis.
  • Modified CTA-based Plaque-RADS classification applied to carotid plaques.
  • Assessment of plaque thickness, ulceration, and intraplaque hemorrhage.
  • Comparison of high-risk (Plaque-RADS 3 and 4) vs. low-risk (Plaque-RADS 1 and 2) plaque subtypes.

Main Results:

  • Plaques ipsilateral to the stroke side showed a higher prevalence of high-risk Plaque-RADS subtypes (42.6% for Plaque-RADS 3, 1.1% for Plaque-RADS 4) compared to the contralateral side (31.9% for Plaque-RADS 3, 0% for Plaque-RADS 4).
  • Plaques ipsilateral to stroke were significantly associated with high-risk Plaque-RADS subtypes (adjusted odds ratio, 2.10; P=0.01).
  • The modified CTA-based Plaque-RADS classification demonstrated potential utility in identifying causative carotid plaque phenotypes.

Conclusions:

  • Carotid plaque ipsilateral to the stroke side is significantly associated with CTA-based high-risk Plaque-RADS subtypes in ESUS patients.
  • A CTA-based Plaque-RADS classification may aid in identifying potentially causative carotid plaque phenotypes.
  • This classification system offers a valuable tool for stroke evaluation and risk stratification.
Abstract

Keywords:
atherosclerosiscarotid stenosisembolic strokehemorrhagehospitalsstroke

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