Risk Prediction of Recurrent Ischemic Stroke Based on Carotid Plaque-RADS: Construction and Validation of a Nomogram Model

Miao QiaoTing ZhouRui WangYanhui Jiangtao Hui Liangcui Ling Meng^*

• The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China

Background and purpose: Ischemic stroke (IS) is characterized by a high recurrence rate and more serious repercussions. Recently, the Carotid Plaque Reporting and Data System (Carotid Plaque-RADS) has been introduced to gauge and forecast the risk of cerebrovascular incidents. More studies are required to confirm its predictive power for recurrent ischemic stroke (RIS). We aimed to create a nomogram model that can evaluate the likelihood of RIS, with Carotid Plaque-RADS serving as a crucial instrument in this model. Methods: We carried out a retrospective review of 286 patients diagnosed with acute ischemic stroke at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine between January 2020 and January 2025. The study population consisted of two groups: the IS group (129 patients) and the RIS group (157 patients), depending on whether they experienced a recurrence of ischemic stroke.Carotid ultrasound examination and clinical data were gathered and classified according to Carotid Plaque-RADS. Independent risk factors for the RIS were determined using multivariate logistic regression analyses. Subsequently, we developed a nomogram model to forecast RIS risk and evaluated its performance. Results: The RIS and IS groups showed significant differences in low-density lipoprotein(LDL), hypertension, atrial fibrillation, severe carotid stenosis, and Carotid Plaque-RADS categoriy. Multivariate logistic regression analysis identified LDL, hypertension , atrial fibrillation, severe carotid stenosis, and Carotid Plaque-RADS as independent risk factors for RIS. The nomogram model built using these risk factors demonstrated good calibration (H-L goodness-of-fit test P = 0.354). Internal and external validation demonstrated that the calibration curves were consistent with the original curves. The nomogram model combining Carotid Plaque-RADS and clinical features showed AUC values of 0.79 and 0.76, outperforming models using only clinical features (AUC 0.72 and 0.70) or only Carotid Plaque-RADS (AUC 0.71 and 0.69).The model showed considerable clinical benefit within the 0.2 to 0.8 threshold range in the Decision Curve Analysis (DSA). Conclusion: The nomogram model based on Carotid Plaque-RADS provides a novel and effective tool for clinical risk assessment and demonstrates favorable predictive performance for RIS.