Reading the Plaque, Not the Pipe: A New Lens on Stroke Risk

Key Takeaway

In a 510-patient imaging study drawn from the CONVINCE trial, stroke and TIA survivors whose CT scans showed high-risk carotid plaque (a Plaque-RADS score of 3 or higher) had about 7.8 times the hazard of another stroke on the same side of the brain. These same patients appeared to gain the most from low-dose colchicine, with roughly a 65% lower risk of major cardiovascular events. What the plaque looks like may matter as much as how narrow the artery is.

The Artery That Looked Fine on Paper

Picture a 67-year-old retired engineer who notices his right hand go clumsy while buttoning his shirt. Within an hour the weakness fades. In the emergency department, the scan of his neck arteries shows that his left carotid is narrowed by about 40%. By the rules that have guided stroke care for 30 years, that is a reassuring number. It falls below the 50% or 70% thresholds that usually trigger surgery, so he goes home on aspirin and a statin.

That number measures only how much…