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4 . 2025

Ultrasound aspects of the application of Carotid Plaque-RADS, a risk stratification system for acute ischemic cerebral events

Abstract

Background. Stratification of the risk of acute ischemic cerebrovascular events in atherosclerotic carotid artery stenosis is an urgent task, which has traditionally been based on the degree of narrowing of the arterial lumen, underestimating the role of morphological characteristics of plaque. In 2024, a new Carotid Plaque system, RADS, was proposed, standardizing the morphological description of plaques revealed by different imaging modalities and supplementing the assessment of the degree of stenosis by NASCET.

Objective. The purpose of this work was to identify the possibilities and limitations of ultrasound examination within the framework of the Carotid Plaque-RADS classification as a first-line diagnostic method.

Сontent of the review. Ultrasound criteria of Carotid Plaque RADS 1–4 categories are described: normal wall (RADS 1); uncomplicated eccentric plaques <3 mm high (RADS 2) and plaques ≥3 mm high with a thick/thin fibrous covering or healed ulceration regardless of their height (RADS 3a/3b/3c); complicated plaques with hemorrhage, fibrous cap rupture or parietal thrombus (RADS 4a/4b/4c). Additional signs of instability (calcifications, neovascularization, inflammation, positive remodeling, “plaque loading”, stenosis progression) and modifiers affecting the quality of ultrasound imaging are considered. A moderately high accuracy of the ultrasound method in the identification of key plaque components was demonstrated, while certain limitations remain in the differentiation of a thin/thick plaque cap, healed ulceration/rupture of the fibrous membrane, as well as in the distinction of the lipid necrotic core, intraplaque hemorrhage and parietal thrombus. The algorithm of a structured ultrasound conclusion is described.

Conclusion. The Carotid Plaque-RADS classification unifies the description of plaque characteristics, facilitates interdisciplinary communication, and improves patient selection for surgical treatment, but is currently not included in professional guidelines and requires further validation in large centers and prospective studies. Ultrasound evaluation of individual plaque components requires further refinement, possibly with the development of new software approaches.

Keywords: Carotid Plaque-RADS; ischemic stroke; ultrasound diagnostics; atherosclerotic plaque; carotid arteries

Funding. The study had no financial support.

Conflict of interest. The authors declare no conflicts of interest.

Authors’ contribution. Study conception and design, data collection and handling, draft manuscript preparation, manuscript revision – Balakhonova T.V., Timina I.E., Chechetkin A.O., Shulgina L.E.

For citation: Balakhonova T.V., Timina I.E., Chechetkin A.O., Shulgina L.E. Ultrasound aspects of the application of Carotid Plaque-RADS, a risk stratification system for acute ischemic cerebral events. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (4): 22–32. DOI: https://doi.org/10.33029/1027-6661-2025-31-4-22-32

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CHIEF EDITOR
CHIEF EDITOR
Yuri V. Belov
Academician of the Russian Academy of Sciences Doctor of Medical Sciences, Professor, President of the Russian Society of Angiologists and Vascular Surgeons

 

In accordance with the decision of the Presidium of the Russian Society of Angiologists and Vascular Surgeons, the journal "Angiology and Vascular Surgery" will be named after Academician A.V. Pokrovsky starting from No. 2/2022.

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