从斑块精准评估到个体化决策：Plaque-RADS分级系统引领高龄患者CEA安全阈值的再定义

From Plaque-Specific Assessment to Personalized Decision-Making: The Plaque-RADS Classification System Redefines Safety Thresholds for CEA in Elderly Patients

摘要: 本文系统阐述了Plaque-RADS分级系统在高龄患者颈动脉疾病管理中的应用价值及其对CEA手术决策的革新意义。作为新型影像评估体系，Plaque-RADS通过整合斑块厚度、溃疡、内出血等关键形态学特征，构建了四级风险分层标准(Plaque-RADS 1-4)，突破了传统狭窄度评估的局限。研究证实，该系统对中轻度狭窄但斑块不稳定的患者具有独特识别价值，其中Plaque-RADS 3-4患者卒中风险显著升高，为临床决策提供了新依据。针对高龄患者的手术风险难题，Plaque-RADS实现了三大突破：首先，将CEA适应症从单纯狭窄标准拓展至斑块易损性评估；其次，通过量化年龄相关风险因素，优化围术期风险评估模型；第三，指导个体化治疗选择，如对高风险患者优先选择CEA而非支架治疗。临床数据显示，该系统使卒中预测的净重分类改善达63.8%，显著提升了手术决策的精准度。Plaque-RADS的应用标志着颈动脉疾病管理进入精准医疗时代，其多维度评估模式为高龄患者提供了更科学的手术安全阈值界定标准，具有重要的临床推广价值。

Abstract: This study comprehensively elucidates the clinical value of the Plaque-RADS classification system in the management of carotid artery disease among elderly patients and its transformative significance for CEA surgical decision-making. As an advanced imaging evaluation system, Plaque-RADS establishes a four-tier risk stratification standard (Plaque-RADS 1-4) by integrating critical morphological characteristics including plaque thickness, ulceration, and intraplaque hemorrhage, thereby overcoming the limitations of traditional stenosis-based assessment. Clinical studies confirm the system's unique capability to identify patients with moderate-to-mild stenosis but unstable plaques, demonstrating that Plaque-RADS 3-4 patients exhibit significantly elevated stroke risk, providing novel evidence for clinical decision-making. Regarding surgical risk management in elderly patients, Plaque-RADS achieves three major breakthroughs: Expansion of CEA indications from stenosis-based criteria to comprehensive plaque vulnerability assessment; Optimization of perioperative risk evaluation models through quantification of age-related risk factors; Guidance for personalized treatment selection, including preferential CEA over stenting for high-risk patients. Clinical data demonstrate that this system achieves a net reclassification improvement of 63.8% in stroke prediction, significantly enhancing decision-making precision. The implementation of Plaque-RADS marks the advent of precision medicine in carotid disease management, with its multidimensional assessment model establishing more scientific safety thresholds for elderly patients, underscoring its significant clinical value for widespread adoption.