不明来源栓塞性卒中患者中基于CTA的高危颈动脉斑块-RADS亚型的患病率
Prevalence of High-Risk CTA-Based Carotid Plaque-RADS Subtypes in Patients With Embolic Stroke of Undetermined Source.
作者信息
Song Jae W, Phi Huy Q, Koneru Manisha, Cao Quy, Rubin Jeremy, Sakai Yu, Ibrahim Lamya, Zhou Sonya E, Woo John H, Kasner Scott E, Saba Luca, Cucchiara Brett L
机构信息
Departments of Radiology (J.W.S., Y.S., J.H.W.), University of Pennsylvania, PA.
Drexel University College of Medicine, Philadelphia, PA (H.Q.P.).
出版信息
Stroke. 2025 Mar;56(3):737-740. doi: 10.1161/STROKEAHA.124.048305. Epub 2025 Jan 24.
BACKGROUND
A modified computed tomography angiography (CTA)-based Carotid Plaque Reporting and Data System (Plaque-RADS) classification was applied to a cohort of patients with embolic stroke of undetermined source to test whether high-risk Plaque-RADS subtypes are more prevalent on the ipsilateral side of stroke. With the widespread use of CTA for stroke evaluation, a CTA-based Plaque-RADS would be valuable for generalizability.
METHODS
A retrospective observational cross-sectional study was conducted at a single integrated health system comprised of 3 hospitals with a comprehensive stroke center between October 1, 2015, and April 1, 2017. Patients with unilateral anterior circulation stroke and <50% carotid stenosis on CTA were retrospectively identified. Maximum plaque thickness and ulceration were assessed by a neuroradiologist blinded to the stroke side. A semiautomated segmentation software measured intraplaque hemorrhage volumes. Modified CTA-based Plaque-RADS classification was defined as (1) no plaque, (2) plaque thickness <3 mm, (3) plaque thickness ≥3 mm or ulcerated, and (4) plaque with intraplaque hemorrhage >50 mm irrespective of plaque thickness. High-risk plaque subtypes (Plaque-RADS 3 and 4) were compared with low-risk subtypes (Plaque-RADS 1 and 2).
RESULTS
Ninety-four patients (55% women; median age, 66 years) were included. CTA-based Plaque-RADS categories for plaques ipsilateral to the stroke side were as follows: (1) 14.9%, (2) 42.6%, (3) 41.5%, and (4) 1.1%. Carotid plaques contralateral to stroke side were Plaque-RADS: (1) 21.3%, (2) 46.8%, (3) 31.9%, and (4) 0%. When compared with the contralateral side, plaques ipsilateral to the stroke side were significantly associated with high-risk Plaque-RADS subtypes in a mixed-effects logistic model adjusting for age and sex (adjusted odds ratio, 2.10 [95% CI, 1.20-3.71]; =0.01).
CONCLUSIONS
Carotid plaque ipsilateral to the stroke side was significantly associated with CTA-based high-risk Plaque-RADS subtypes in an embolic stroke of undetermined source cohort. A CTA-based Plaque-RADS classification may be useful for identifying potentially causative carotid plaque phenotypes in patients with embolic stroke of undetermined source.
背景
一种基于改良计算机断层扫描血管造影（CTA）的颈动脉斑块报告和数据系统（Plaque-RADS）分类方法应用于一组不明来源栓塞性卒中患者，以测试高危Plaque-RADS亚型在卒中同侧是否更普遍。随着CTA在卒中评估中的广泛应用，基于CTA的Plaque-RADS在推广方面将具有重要价值。
方法
在一个由3家医院组成的单一综合医疗系统中进行了一项回顾性观察性横断面研究，该系统设有综合卒中中心，研究时间为2015年10月1日至2017年4月1日。回顾性纳入单侧前循环卒中且CTA显示颈动脉狭窄<50%的患者。由对卒中侧不知情的神经放射科医生评估最大斑块厚度和溃疡情况。使用半自动分割软件测量斑块内出血体积。基于CTA的改良Plaque-RADS分类定义为：（1）无斑块，（2）斑块厚度<3mm，（3）斑块厚度≥3mm或有溃疡，（4）无论斑块厚度如何，斑块内出血>50mm。将高危斑块亚型（Plaque-RADS 3和4）与低危亚型（Plaque-RADS 1和2）进行比较。
结果
纳入94例患者（55%为女性；中位年龄66岁）。卒中侧同侧斑块的基于CTA的Plaque-RADS分类如下：（1）14.9%，（2）42.6%，（3）41.5%，（4）1.1%。卒中侧对侧颈动脉斑块的Plaque-RADS分类为：（1）21.3%，（2）46.8%，（3）31.9%，（4）0%。在调整年龄和性别的混合效应逻辑模型中，与对侧相比，卒中侧同侧斑块与高危Plaque-RADS亚型显著相关（调整后的优势比为2.10 [95% CI，1.20 - 3.71]；P = 0.01）。
结论
在不明来源栓塞性卒中队列中，卒中侧同侧颈动脉斑块与基于CTA的高危Plaque-RADS亚型显著相关。基于CTA的Plaque-RADS分类可能有助于识别不明来源栓塞性卒中患者中潜在的致病因颈动脉斑块表型。
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