Carotid Plaque-RADS in risk stratification for ischemic stroke using duplex ultrasound: a narrative review

Ischemic cerebrovascular events are the second leading cause of death worldwide, with carotid atherosclerosis being a key risk factor. Although duplex ultrasound (DU) is the initial screening method, its predictive power in determining plaque vulnerability is often questioned due to high inter-operator variability. This limitation underscores the need for standardized protocols to strengthen the predictive value of ultrasound in stroke risk assessment. This review focused on analyzing the implementation of the Plaque-RADS model for the sonographic evaluation of carotid plaques and its potential impact on standardizing and stratifying the risk of thromboembolic stroke. The literature review highlighted the importance of pathophysiological structures like the necrotic core and fibrous cap, and how describing these features is useful for classifying stroke risk based on the four risk categories proposed in the Plaque-RADS system. The main conclusion is that the systematic adoption of the Plaque-RADS system could reduce inter-operator variability, thereby enhancing the reproducibility and predictive value of DU for ischemic stroke risk. However, as this is a relatively new model, larger-scale research is required to validate its results and integrate it into established clinical protocols.