Abstract Background and aims In patients with carotid atherosclerosis, stroke risk stratification is mainly based on stenosis severity, although other carotid artery plaque (CAP) characteristics may better reflect vulnerability. This study examined associations between Computed Tomography Angiography (CTA)-derived plaque features and recurrent vascular events in patients with non-cardioembolic stroke or transient ischemic attack (TIA). Methods Baseline CTAs from 517 patients in the CONVINCE (Colchicine for prevention of vascular inflammation in Non-CardioEmbolic stroke) trial were analysed for various plaque features, including total and non-calcified plaque thickness, stenosis, plaque burden, plaque ulceration, and plaque (subcomponent) volumes. In patients with a symptomatic CAP (i.e. CAP proximal to the index ischaemic lesion), associations with recurrent ipsilateral ischaemic stroke, any stroke/TIA, and major adverse cardiovascular events (MACE) were assessed using adjusted Cox proportional hazards models. Results We identified 579 CAPs in 517 patients. Among 195 patients with symptomatic CAPs (33.7%), 12 patients (6.2%) reached the primary endpoint (recurrent ipsilateral ischaemic stroke) during a median follow-up of 35.9 months. Any stroke/TIA occurred in 25 patients (12.8%), and MACE in 27 patients (13.8%). Total plaque thickness ≥ 3 mm was associated with increased risk of ipsilateral stroke (adjHR 8.15; 95%CI 1.02-64.89), any stroke/TIA (adjHR 6.67; 95%CI 1.54-28.88) and MACE (adjHR 3.42; 95%CI 1.15-10.11). Conclusions Total plaque thickness ≥ 3 mm may serve as a predictive marker to identify patients at higher risk of recurrent stroke and MACE. This plaque feature could be informative for trial design and clinical decisions in relation to carotid revascularization. Conflict of interest Tim Cassidy should also be considered an author. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. Figure 1 - belongs to Methods Table 1 - belongs to Results Figure 2 - belongs to Conclusions
Maes et al. (2026) studied this question.