# Carotid Plaque-RADS improves preoperative coronary risk stratification in candidates for carotid revascularization

## TL;DR

Carotid Plaque-RADS is a noninvasive imaging tool that helps predict coronary artery issues in patients needing carotid revascularization.

## Contribution

Carotid Plaque-RADS is shown to independently predict coronary functional stenosis in carotid revascularization candidates.

## Key findings

- Carotid Plaque-RADS remained an independent predictor of coronary functional stenosis after adjustment.
- It demonstrated good diagnostic performance with an AUC of 0.81, sensitivity of 85%, and specificity of 68%.
- Carotid Plaque-RADS was moderately correlated with CAD-RADS and predicted CAD-RADS ≥ 3 with good discrimination.

## Abstract

In this retrospective study, we aimed to assess the predictive value of the Carotid Plaque-RADS (Reporting and Data System) for coronary functional stenosis in candidates for carotid revascularization, using high-resolution magnetic resonance imaging (HR-MRI) coupled with computed tomography-derived fractional flow reserve (CT-FFR).

A retrospective analysis was performed on data of 101 patients with carotid atherosclerosis who underwent HR-MRI for Carotid Plaque evaluation, and CT-FFR for coronary assessment was conducted. Patients were divided into two groups based on a CT-FFR threshold of ≤ 0.80. Logistic regression, correlation analyses, and receiver operating characteristic curve analyses were used to identify predictors of coronary functional stenosis.

In the functional stenosis group (n = 76), both plaque volume and Carotid Plaque-RADS categories had higher values than those observed in the non-functional group (n = 25). Univariate analysis showed that Carotid Plaque-RADS, Carotid Plaque volume, and hypertension were associated with functional stenosis. After adjustment, Carotid Plaque-RADS remained an independent predictor (odds ratio: 2.35, p < 0.01) and demonstrated the strongest correlation (ρ = 0.51, p < 0.01). It also demonstrated good diagnostic performance (area under the curve [AUC]: 0.81; sensitivity: 85%; specificity: 68%) and favorable clinical utility on decision curve analysis. In an exploratory analysis, Carotid Plaque-RADS was also moderately correlated with CAD-RADS (ρ = 0.37, p < 0.01) and predicted CAD-RADS ≥ 3 with good discrimination (AUC: 0.72).

Carotid Plaque-RADS is an independent, noninvasive predictor of coronary functional stenosis in candidates for carotid revascularization.

Carotid Plaque-RADS provides a noninvasive imaging-based tool that independently predicts coronary functional stenosis, thereby enhancing preoperative coronary risk stratification and supporting integrated cardiovascular management in candidates for carotid revascularization.

Carotid revascularization candidates face high coronary risk.Carotid Plaque-RADS independently predicts coronary functional stenosis.Carotid Plaque-RADS enhances preoperative coronary risk stratification.

Carotid revascularization candidates face high coronary risk.

Carotid Plaque-RADS independently predicts coronary functional stenosis.

Carotid Plaque-RADS enhances preoperative coronary risk stratification.