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

BACKGROUND AND PURPOSE: Plaque-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 METHODS: Symptomatic patients were recruited from the Chinese Atherosclerosis Risk Evaluation, NCT 02017756 (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.

RESULTS: A 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%]; P = .01), Plaque-RADS score (≥3: 33.9% versus 28.4%; P = .02), and max-NWI (0.53 [SD, 0.14] versus 0.51 [SD, 0.13]; P = .002) compared with the asymptomatic side. Plaque RADS was significantly associated with cerebrovascular events (OR = 1.11 per 1-level increase; 95% CI, 1.01–1.24; P = .04). In patients with mild/moderate bilateral carotid artery stenosis, plaque RADS ≥3 was significantly associated with symptomatic events (OR = 1.30; 95% CI, 1.01–1.68; P = .04). Higher Plaque-RADS on the symptomatic side was related to advanced age (OR = 1.27 per 10-year increase; 95% CI, 1.03–1.56; P = .03), male sex (OR = 1.90; 95% CI, 1.05–3.43; P = .03), and smoking history (OR = 1.99; 95% CI, 1.20–3.31; P = .007).

CONCLUSIONS: Male 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.