CTA-Based Carotid Plaque Reporting and Data System Classification Improves Risk Stratification for Ischemic...

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.