Huang Zhe, Cheng Xue-Qing, Lu Rui-Rui, Bi Xiao-Jun, Liu Ya-Ni, Deng You-Bin
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
JACC Cardiovasc Imaging. 2025 Jan;18(1):77-89. doi: 10.1016/j.jcmg.2024.07.004. Epub 2024 Sep 4.
Recently, a standardized classification system for carotid atherosclerotic plaques, known as Carotid Plaque-RADS (Reporting and Data System), has been introduced. However, its capacity to improve stroke risk stratification beyond traditional stenosis degree assessment has not been extensively explored.
This study aimed to determine the incremental prognostic value of Carotid Plaque-RADS over stenosis degree for stroke risk.
A retrospective analysis was performed on data from January 2010 to December 2021, involving subjects who underwent magnetic resonance imaging, computed tomography angiography, and ultrasound evaluations of the carotid artery. Disease-free survival (DFS) and recurrence-free survival (RFS) rates were compared across different stenosis degrees, Carotid Plaque-RADS categories, and their combination, using the Kaplan-Meier and net reclassification improvement formula.
The study enrolled 1,378 subjects. During a follow-up period of 57 ± 25 months, 4.6% of 987 asymptomatic individuals and 16.9% of 391 subjects with stroke history experienced initial and recurrent strokes, respectively. Significant differences in DFS and RFS rates were found between subjects with mild/moderate and severe stenosis (P < 0.001). Significant differences in DFS rates were observed across Carotid Plaque-RADS categories (P < 0.001), with a notable decrease in DFS rates as Carotid Plaque-RADS categories increased from 1 to 4. This trend was similar in subjects with a history of stroke (P < 0.001). For patients with mild/moderate stenosis, significant differences in DFS and RFS rates were found between those with Carotid Plaque-RADS of ≥3 vs <3 (P < 0.001). Correct reclassification was achieved for 3.3% (32 of 979) of asymptomatic individuals and 9.7% (37 of 381) of subjects with a stroke history initially identified with mild/moderate stenosis. Incorporating Carotid Plaque-RADS with stenosis grading markedly improved risk assessment, resulting in net reclassification improvement of 63.8% for initial stroke and 47.8% for recurrent stroke prediction. The likelihood ratio test demonstrated that Carotid Plaque-RADS scores significantly enhanced the prognostic accuracy of stenosis degrees for both asymptomatic individuals and patients with a history of stroke (both P < 0.001).
Carotid Plaque-RADS significantly improves stroke risk stratification over traditional stenosis grading, especially in mild/moderate stenosis cases.
最近，一种用于颈动脉粥样硬化斑块的标准化分类系统，即颈动脉斑块报告和数据系统（Carotid Plaque-RADS）已被引入。然而，其在传统狭窄程度评估之外改善中风风险分层的能力尚未得到广泛探索。
本研究旨在确定Carotid Plaque-RADS相对于狭窄程度在中风风险方面的增量预后价值。
对2010年1月至2021年12月的数据进行回顾性分析，纳入接受颈动脉磁共振成像、计算机断层血管造影和超声评估的受试者。使用Kaplan-Meier法和净重新分类改善公式，比较不同狭窄程度、Carotid Plaque-RADS类别及其组合的无病生存率（DFS）和无复发生存率（RFS）。
该研究共纳入1378名受试者。在57±25个月的随访期内，987名无症状个体中有4.6%、391名有中风病史的个体中有16.9%分别发生了初次和复发性中风。轻度/中度狭窄和重度狭窄的受试者在DFS和RFS率上存在显著差异（P<0.001）。不同Carotid Plaque-RADS类别之间的DFS率存在显著差异（P<0.001），随着Carotid Plaque-RADS类别从1增加到4，DFS率显著下降。有中风病史的受试者也呈现类似趋势（P<0.001）。对于轻度/中度狭窄的患者，Carotid Plaque-RADS≥3与<3的患者在DFS和RFS率上存在显著差异（P<0.001）。最初被确定为轻度/中度狭窄的无症状个体中有3.3%（979例中的32例）、有中风病史的个体中有9.7%（381例中的37例）实现了正确的重新分类。将Carotid Plaque-RADS与狭窄分级相结合显著改善了风险评估，初次中风预测的净重新分类改善为63.8%，复发性中风预测为47.8%。似然比检验表明，Carotid Plaque-RADS评分显著提高了无症状个体和有中风病史患者狭窄程度的预后准确性（两者P<0.001）。
与传统的狭窄分级相比，Carotid Plaque-RADS显著改善了中风风险分层，尤其是在轻度/中度狭窄病例中。
