CTA-Based Carotid Plaque Reporting and Data System Classification Improves Risk Stratification for Ischemic
Limei Deng1, Weixiong Zeng1, Jingjing Yang1
1From the Department of Diagnostic Imaging (L.D., W. Zeng, J.Y., Z.H., Y.L., G.Q., W.C.), Nanfang Hospital, Southern Medical University, Guangzhou, China.
Insights
Carotid Plaque-RADS on CTA improves risk assessment for ischemic cerebrovascular events (ICE) beyond stenosis severity alone. This system aids in identifying high-risk plaques, especially in mild to moderate stenosis, guiding earlier intervention for better outcomes.
Area of Science:
- Vascular imaging and neurology.
- Radiology and cardiovascular disease research.
Background:
- Ischemic cerebrovascular events (ICE) are a major cause of death and disability.
- Carotid Plaque-RADS standardizes plaque assessment, but its prognostic value via CTA needs further exploration.
Purpose of the Study:
- To evaluate the prognostic value of CTA-based Carotid Plaque-RADS for predicting ICE.
- To compare the performance of Carotid Plaque-RADS with carotid stenosis severity in risk stratification.
Main Methods:
- Retrospective analysis of 1,232 patients who underwent neck CTA, with 371 matched pairs using propensity score matching (PSM).
- Independent assessment of carotid plaques using CTA-based Carotid Plaque-RADS by two radiologists.
- Follow-up of 742 patients for a mean of 42 months to assess stroke outcomes using logistic regression, ROC, and Cox models.
Main Results:
- Plaque-RADS ≥3 was more frequent in symptomatic patients and correlated with ICE.
- Plaque-RADS 4c (intraluminal thrombus) showed the strongest prediction for ischemic events (OR 17.87).
- Carotid Plaque-RADS significantly improved risk model discrimination (AUC 0.680 vs. 0.609) and identified as an independent risk factor for disease-free survival (DFS) and recurrence-free survival (RFS).
Conclusions:
- CTA-based Carotid Plaque-RADS provides superior risk stratification for ICE compared to stenosis severity alone.
- The system is particularly valuable in patients with mild to moderate stenosis.
- Carotid Plaque-RADS may assist in guiding earlier interventions for patients at high risk of cerebrovascular events.
Background And Purpose:
Ischemic cerebrovascular events (ICE) remain a leading cause of mortality and disability. The carotid Plaque Reporting and Data System (Plaque-RADS) standardizes plaque vulnerability assessment, but its prognostic value based solely on CTA remains underexplored.
Materials And Methods:
Of 7228 patients who underwent neck CTA (2019-2024), 1232 were retrospectively included and divided into symptomatic and asymptomatic groups. Propensity score matching yielded 371 matched pairs. Two radiologists independently assessed plaques using CTA-based carotid Plaque-RADS, incorporating features such as wall thickness, ulceration, intraplaque hemorrhage, and thrombus. A total of 742 patients were followed (mean, 42 [SD, 18] months) for stroke outcomes. Logistic regression, receiver operating characteristic, and Cox models were used to assess the diagnostic and prognostic performance compared with stenosis severity.
Results:
Plaque-RADS ≥3 was significantly more common in symptomatic patients (P < .001) and showed a moderate correlation with ICE (Kendall τ-b = 0.23; P < .001). Among the Plaque-RADS categories, Plaque-RADS 4c (intraluminal thrombus) exhibited the strongest predictive value for ischemic events (OR, 17.87; 95% CI, 6.09-52.42, P < .001). Adding Plaque-RADS to the base model (stenosis degree and clinical covariates) significantly improved model discrimination (area under the curve, 0.609, 95% CI, 0.577-0.641 versus area under the curve, 0.680; 95% CI, 0.649-0.711; DeLong P <.001). Plaque-RADS ≥3 and severe stenosis were identified as independent risk factors for both disease-free survival (DFS) and recurrence-free survival (RFS) based on Cox multivariate regression. Higher Plaque-RADS categories were significantly associated with lower DFS and RFS, particularly in patients with mild-to-moderate stenosis.
Conclusions:
CTA-based carotid Plaque-RADS offers superior risk stratification for ICE compared with stenosis severity alone, especially in mild/moderate stenosis, and may guide earlier interventions.
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