CTA-Based Plaque-RADS to Assess Etiologic Role of Nonstenotic Carotid Plaques in Patients With Embolic Stroke of Undetermined Source.

Inter-rater agreement for CTA-based Plaque-RADS classification of nonstenotic carotid plaques was excellent.

• Cohen κ = 0.83, p < 0.001
• Assessment was performed in a cohort of 512 consecutive ESUS patients
• The classification system used a modified CTA-based Plaque-RADS with categories 1-4 based on wall thickness, ulceration, intraplaque hemorrhage, and intraluminal thrombus

High-risk Plaque-RADS scores were significantly more frequent ipsilateral to the stroke than contralateral.

• Ipsilateral high-risk Plaque-RADS prevalence: 21.3% vs contralateral 11.9%
• Adjusted odds ratio 2.65, 95% CI 1.73–4.06, p < 0.001
• 109 of 512 patients (21.3%) had ipsilateral high-risk (categories 3–4) and 403 (78.7%) had low-risk (categories 1–2) Plaque-RADS scores

Ipsilateral high-risk Plaque-RADS scores were inversely associated with atrial cardiopathy as a competing cardioembolic source.

• Atrial cardiopathy prevalence: 34.9% in high-risk vs 39.2% in low-risk Plaque-RADS group
• Adjusted odds ratio 0.59, 95% CI 0.36–0.96, p = 0.036

Ipsilateral high-risk Plaque-RADS scores were inversely associated with high-risk patent foramen ovale as a competing cardioembolic source.

• High-risk PFO prevalence: 2.7% in high-risk vs 21.8% in low-risk Plaque-RADS group
• Adjusted odds ratio 0.14, 95% CI 0.03–0.60, p = 0.008

Ipsilateral high-risk Plaque-RADS scores were inversely associated with atrial fibrillation detected after stroke.

• Atrial fibrillation detected after stroke: 8.4% in high-risk vs 17.5% in low-risk Plaque-RADS group
• Adjusted subdistribution hazard ratio 0.46, 95% CI 0.23–0.95, p = 0.037
• Analysis performed using competing risks survival analysis

Ipsilateral high-risk Plaque-RADS scores were significantly associated with an increased risk of ipsilateral stroke recurrence during follow-up.

• Ipsilateral stroke recurrence: 11.2% in high-risk vs 3.0% in low-risk Plaque-RADS group
• Adjusted subdistribution hazard ratio 3.19, 95% CI 1.15–8.83, p = 0.026
• Overall stroke recurrence did not significantly differ between groups
• Follow-up period spanned January 2016 to June 2025 in a single-center cohort

The study population consisted of 512 consecutive ESUS patients with unilateral anterior circulation stroke and neck CTA.

• Median age 70 years, 47.8% women
• Single-center cohort study with both retrospective and prospective enrollment from January 2016 to June 2025
• Patients were included if they had unilateral anterior circulation stroke and available neck CTA
• NSCPs were defined as less than 50% stenosis