Carotid Plaque-RADS: A Novel Stroke Risk Classification System

JACC Cardiovasc Imaging. 2024 Jan;17(1):62-75. doi: 10.1016/j.jcmg.2023.09.005. Epub 2023 Oct 11.


Background: Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features.

Objectives: The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score.

Methods: A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports.

Results: The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories.

Conclusions: Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists.

Keywords: Plaque-RADS; atherosclerosis; carotid plaque; carotid stenosis; complicated plaque; plaque imaging; reporting and data system; stroke.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Carotid Arteries / diagnostic imaging
  • Carotid Artery Diseases* / complications
  • Carotid Artery Diseases* / diagnostic imaging
  • Carotid Artery Diseases* / therapy
  • Carotid Stenosis* / complications
  • Humans
  • Ischemic Stroke* / complications
  • Magnetic Resonance Imaging / adverse effects
  • Plaque, Atherosclerotic*
  • Predictive Value of Tests
  • Stroke* / complications
  • Stroke* / etiology
  • Tomography, X-Ray Computed / adverse effects