Plaque-Reporting and Data System Related to Cerebrovascular Event Risk with Mild/Moderate Stenosis: A Chinese Atherosclerosis Risk Evaluation II Study.

background and purposePlaque-Reporting and Data System (Plaque-RADS) provides a standardized approach for evaluating carotid plaque morphology and composition. The aim of this study was to evaluate carotid Plaque-RADS and its relationship to clinical risk factors and ipsilateral cerebrovascular symptoms, in a prospectively-acquired multicenter, vessel wall MRI data set. MATERIALS AND

methodsSymptomatic patients were recruited from the Chinese Atherosclerosis Risk Evaluation, NCT02017756 (CARE-II) study. This cross-sectional study included patients with recent stroke or TIA and atherosclerotic plaques in at least 1 carotid artery. Lipid-rich necrotic core, ulceration, intraplaque hemorrhage, a thick or thin fibrous cap, fibrous cap rupture, and intraluminal thrombi were identified from multiple-contrast vessel wall imaging and were used to determine carotid Plaque-RADS. In addition, ancillary features including calcification and plaque burden via the maximum normalized wall index (max-NWI) were collected. The degree of stenosis was classified as mild (<30%), moderate (30%-69%), and severe (70%-99%). Generalized estimating equation-based logistic regression was performed to assess the relationship between the Plaque-RADS score and cerebrovascular events.

resultsA total of 433 patients (62 [SD, 9.97] years, 302 men [69.7%]) with 866 carotid arteries were included in this study. Symptomatic carotid arteries had a higher stenosis degree (11.8% [SD, 24.7%] versus 8.6% [SD, 18.8%];

conclusionsMale patients of advanced age with a smoking history were associated with an increased risk of higher Plaque-RADS scores. Plaque-RADS demonstrated the ability to stratify patients experiencing cerebrovascular events, even in cases with mild-to-moderate stenosis. However, this association lost statistical significance after adjusting for stenosis or max-NWI.