The predictive value of Plaque-RADS classification in two-dimensional carotid ultrasound for stroke risk
Yuanfu Ouyang1, Guorong Lyu2, Shaomin Huang1
1Department of Medical Ultrasonics, Sanming Second Hospital, Fifth Clinical Medical College, Fujian University of Traditional Chinese Medicine, Yong'an, China.
Background:
The Carotid Plaque Reporting and Data System (Plaque-RADS) standardizes plaque risk assessment, but its ability to predict the prevalence of stroke has not yet been fully investigated. This study aimed to evaluate the association between the Plaque-RADS categories and stroke prevalence in a large prospective cohort using two-dimensional (2D) carotid ultrasound.
Methods:
In total, 2,023 patients undergoing carotid ultrasound were enrolled in this prospective cohort study. Stroke risk was stratified using Plaque-RADS categories 1-4. Based on clinical diagnosis, the patients were categorized into stroke and non-stroke groups. The associations between the Plaque-RADS categories and stroke prevalence/recurrence were analyzed by multivariate logistic regression, adjusted for gender, age, and diabetes mellitus. A linear trend test was performed across the ordinal categories.
Results:
The stroke group (n=212) had a higher proportion of males (65.1% vs. 56.5%, P<0.05), an older median age (70.5 vs. 63 years, P<0.05), and a higher prevalence of diabetes (42.6% vs. 29.3%, P<0.05) than the non-stroke group (n=1,811). The prevalence of stroke increased significantly across the Plaque-RADS categories: 3.1% (13/412) in category 1, 10.1% (121/1,198) in category 2, 17.2% (65/379) in category 3, and 38.2% (13/34) in category 4 (trend P<0.001). After adjustment for confounders, Plaque-RADS category 4 conferred the highest stroke risk (adjusted odds ratio =8.13, 95% confidence interval: 3.18-20.78), with a significant linear trend in risk across categories (P for trend <0.001). In relation to short-term (0-12 months) stroke recurrence among the 199 stroke patients, the recurrence rates demonstrated a graded association with the Plaque-RADS categories (P=0.008): 10.7% (13/121) in category 2, 23.1% (15/65) in category 3, and 38.5% (5/13) in category 4. This association was particularly strong in the 0-6-month period.
Conclusions:
The Plaque-RADS classification, as applied in 2D carotid ultrasound, effectively stratifies both initial and short-term recurrent stroke risk, supporting its integration into routine clinical practice for risk assessment.
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