Carotid Plaque-RADS improves preoperative coronary risk stratification in candidates for carotid revascularization
Rui Qin1,2, Chong Zheng1,2, Yue Zhang1,2
1Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Changchun Street, No. 45, 100053, Beijing, China.
Insights
Carotid Plaque-RADS effectively predicts coronary functional stenosis in patients undergoing carotid revascularization. This noninvasive imaging tool aids in preoperative risk assessment for better cardiovascular management.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Interventional Cardiology
Background:
- Patients undergoing carotid revascularization often have high coronary risk.
- Accurate preoperative risk stratification is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the predictive value of Carotid Plaque-RADS for coronary functional stenosis.
- To assess the utility of Carotid Plaque-RADS in candidates for carotid revascularization.
Main Methods:
- Retrospective analysis of 101 patients with carotid atherosclerosis.
- Utilized high-resolution magnetic resonance imaging (HR-MRI) for Carotid Plaque evaluation.
- Employed computed tomography-derived fractional flow reserve (CT-FFR) for coronary assessment.
Main Results:
- Carotid Plaque-RADS independently predicted coronary functional stenosis (OR: 2.35, p < 0.01).
- Demonstrated strong correlation (ρ = 0.51, p < 0.01) and good diagnostic performance (AUC: 0.81).
- Exploratory analysis showed moderate correlation with CAD-RADS (ρ = 0.37, p < 0.01).
Conclusions:
- Carotid Plaque-RADS serves as an independent, noninvasive predictor of coronary functional stenosis.
- Enhances preoperative coronary risk stratification for carotid revascularization candidates.
- Supports integrated cardiovascular management by providing valuable imaging-based risk information.
Objectives:
In this retrospective study, we aimed to assess the predictive value of the Carotid Plaque-RADS (Reporting and Data System) for coronary functional stenosis in candidates for carotid revascularization, using high-resolution magnetic resonance imaging (HR-MRI) coupled with computed tomography-derived fractional flow reserve (CT-FFR).
Materials And Methods:
A retrospective analysis was performed on data of 101 patients with carotid atherosclerosis who underwent HR-MRI for Carotid Plaque evaluation, and CT-FFR for coronary assessment was conducted. Patients were divided into two groups based on a CT-FFR threshold of ≤ 0.80. Logistic regression, correlation analyses, and receiver operating characteristic curve analyses were used to identify predictors of coronary functional stenosis.
Results:
In the functional stenosis group (n = 76), both plaque volume and Carotid Plaque-RADS categories had higher values than those observed in the non-functional group (n = 25). Univariate analysis showed that Carotid Plaque-RADS, Carotid Plaque volume, and hypertension were associated with functional stenosis. After adjustment, Carotid Plaque-RADS remained an independent predictor (odds ratio: 2.35, p < 0.01) and demonstrated the strongest correlation (ρ = 0.51, p < 0.01). It also demonstrated good diagnostic performance (area under the curve [AUC]: 0.81; sensitivity: 85%; specificity: 68%) and favorable clinical utility on decision curve analysis. In an exploratory analysis, Carotid Plaque-RADS was also moderately correlated with CAD-RADS (ρ = 0.37, p < 0.01) and predicted CAD-RADS ≥ 3 with good discrimination (AUC: 0.72).
Conclusion:
Carotid Plaque-RADS is an independent, noninvasive predictor of coronary functional stenosis in candidates for carotid revascularization.
Critical Relevance Statement:
Carotid Plaque-RADS provides a noninvasive imaging-based tool that independently predicts coronary functional stenosis, thereby enhancing preoperative coronary risk stratification and supporting integrated cardiovascular management in candidates for carotid revascularization.
Key Points:
Carotid revascularization candidates face high coronary risk. Carotid Plaque-RADS independently predicts coronary functional stenosis. Carotid Plaque-RADS enhances preoperative coronary risk stratification.
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