Key result
Plaque-RADS category 4 linked to ~8.1-fold higher stroke risk vs category 1.
Why the study?
Does Plaque-RADS classification using 2D carotid ultrasound predict the risk of occurrence or recurrence of ischemic stroke in patients undergoing carotid ultrasound?
Cohort (n=2,023)
No
Does Plaque-RADS classification using 2D carotid ultrasound predict the risk of occurrence or recurrence of ischemic stroke in patients undergoing carotid ultrasound?
The application of Plaque-RADS classification using 2D carotid ultrasound effectively stratifies the risk of initial and short-term recurrent ischemic stroke, providing a valuable tool for routine clinical assessment.
Answers are grounded in this paper and cite their sources.
May aid ultrasound-based stroke risk stratification; supports Plaque-RADS but leaves open incremental value over standard assessment.
Background: The Carotid Plaque Reporting and Data System (Plaque-RADS) standardizes plaque risk assessment, but its ability to predict the prevalence of stroke has not yet been fully investigated. This study aimed to evaluate the association between the Plaque-RADS categories and stroke prevalence in a large prospective cohort using two-dimensional (2D) carotid ultrasound. Methods: In total, 2,023 patients undergoing carotid ultrasound were enrolled in this prospective cohort study. Stroke risk was stratified using Plaque-RADS categories 1-4. Based on clinical diagnosis, the patients were categorized into stroke and non-stroke groups. The associations between the Plaque-RADS categories and stroke prevalence/recurrence were analyzed by multivariate logistic regression, adjusted for gender, age, and diabetes mellitus. A linear trend test was performed across the ordinal categories. Results: 29.3%, P<0.05) than the non-stroke group (n=1,811). The prevalence of stroke increased significantly across the Plaque-RADS categories: 3.1% (13/412) in category 1, 10.1% (121/1,198) in category 2, 17.2% (65/379) in category 3, and 38.2% (13/34) in category 4 (trend P<0.001). After adjustment for confounders, Plaque-RADS category 4 conferred the highest stroke risk (adjusted odds ratio =8.13, 95% confidence interval: 3.18-20.78), with a significant linear trend in risk across categories (P for trend <0.001). In relation to short-term (0-12 months) stroke recurrence among the 199 stroke patients, the recurrence rates demonstrated a graded association with the Plaque-RADS categories (P=0.008): 10.7% (13/121) in category 2, 23.1% (15/65) in category 3, and 38.5% (5/13) in category 4. This association was particularly strong in the 0-6-month period. Conclusions: The Plaque-RADS classification, as applied in 2D carotid ultrasound, effectively stratifies both initial and short-term recurrent stroke risk, supporting its integration into routine clinical practice for risk assessment.
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Ouyang et al. (2026) conducted a cohort in Stroke (n=2,023). Plaque-RADS classification (Category 4) vs. Plaque-RADS category 1 was evaluated on Occurrence or recurrence of ischemic stroke (OR 8.13, 95% CI 3.18-20.78, p=<0.001). Plaque-RADS category 4 assessed by 2D carotid ultrasound was associated with a significantly higher risk of stroke compared to category 1 (adjusted OR 8.13), demonstrating a graded risk across categories.
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