BACKGROUND 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. OBJECTIVES This study aimed to determine the incremental prognostic value of Carotid Plaque-RADS over stenosis degree for stroke risk. METHODS 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. RESULTS 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). CONCLUSIONS Carotid Plaque-RADS significantly improves stroke risk stratification over traditional stenosis grading, especially in mild/moderate stenosis cases.

中文翻译：

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颈动脉斑块-RADS 对与中风风险相关的狭窄程度的增量预后价值。


背景技术近来，已经引入了颈动脉粥样硬化斑块的标准化分类系统，称为颈动脉斑块-RADS（报告和数据系统）。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。目的 本研究旨在确定颈动脉斑块-RADS 相对于狭窄程度对中风风险的增量预后价值。方法对 2010 年 1 月至 2021 年 12 月的数据进行回顾性分析，涉及接受磁共振成像、计算机断层扫描血管造影和颈动脉超声评估的受试者。使用 Kaplan-Meier 和净重分类改进公式，比较不同狭窄程度、颈动脉斑块-RADS 类别及其组合的无病生存率 (DFS) 和无复发生存率 (RFS)。结果 该研究招募了 1,378 名受试者。在 57 ± 25 个月的随访期间，987 名无症状个体中的 4.6% 和 391 名有中风史的受试者中的 16.9% 分别经历过初次中风和复发性中风。轻度/中度和重度狭窄受试者之间的 DFS 和 RFS 率存在显着差异 (P < 0.001)。不同颈动脉斑块-RADS 类别之间的 DFS 率存在显着差异 (P < 0.001)，随着颈动脉斑块-RADS 类别从 1 增加到 4，DFS 率显着下降。这种趋势在有中风病史的受试者中相似（P< 0.001）。对于轻度/中度狭窄的患者，颈动脉斑块 RADS ≥3 与 <3 的患者之间的 DFS 和 RFS 率存在显着差异（P < 0.001）。 3 已实现正确的重新分类。3%（979 人中的 32 人）的无症状个体和 9.7%（381 人中的 37 人）有卒中史的受试者最初被诊断为轻度/中度狭窄。将颈动脉斑块-RADS 与狭窄分级相结合可显着改善风险评估，使初次中风的净重分类改善 63.8%，对复发性中风预测净重分类改善 47.8%。似然比检验表明，颈动脉斑块-RADS 评分显着提高了无症状个体和有卒中病史患者的狭窄程度的预后准确性（均为 P < 0.001）。结论 与传统的狭窄分级相比，颈动脉斑块-RADS 显着改善了卒中风险分层，特别是在轻度/中度狭窄病例中。