Neurology · 1 h ago
CTA Plaque-RADS Scores Linked to Recurrent Events After Stroke or TIA
A post hoc observational analysis of 510 CONVINCE trial participants found that higher carotid Plaque-RADS scores were associated with recurrent ischemic and cardiovascular events. Colchicine’s association with fewer major adverse cardiovascular events appeared stronger in patients with scores of 3 or higher, but the subgroup finding is exploratory.
- Higher Plaque-RADS scores were associated with recurrent vascular events.
- Colchicine’s MACE association differed by Plaque-RADS group.
- Post hoc findings require confirmation before guiding treatment.
Researchers analyzed data from 510 participants in the CONVINCE trial across 13 European sites. The post hoc observational cohort analysis assessed computed tomography angiography-based carotid Plaque-RADS scores and subsequent events in people with noncardioembolic stroke or transient ischemic attack. Median age was 67 years, 72.2% were male, and median follow-up was 35.7 months. Analyses included 966 internal carotid arteries; outcomes included recurrent ipsilateral stroke, any stroke or TIA, and major adverse cardiovascular events (MACE).
Among 321 arteries ipsilateral to the index stroke, Plaque-RADS scores of 3 or higher were associated with recurrent ipsilateral stroke (adjusted hazard ratio [HR], 7.80; 95% CI, 1.55–39.30), any stroke or TIA (HR, 3.94; 95% CI, 1.68–9.24), and MACE (HR, 2.52; 95% CI, 1.19–5.34). A treatment-by-score interaction was reported for MACE (P=0.047); in the higher-score group, colchicine was associated with lower risk (HR, 0.35; 95% CI, 0.15–0.82).
The findings suggest CTA plaque morphology may help identify patients at higher risk beyond stenosis classification. However, this was a post hoc analysis with few events, including 12 recurrent ipsilateral strokes, and the treatment subgroup result requires confirmation. It does not establish that Plaque-RADS should guide colchicine treatment.
In practice
In patients with noncardioembolic stroke or TIA, a CTA Plaque-RADS score of 3 or higher was associated with greater subsequent ischemic and cardiovascular event risk in this analysis. The observed variation in colchicine’s association with MACE by score may support further study of plaque imaging for treatment selection, but it does not justify changing practice: this was a post hoc analysis, the event count was limited, and the subgroup finding needs confirmation.
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Stroke: Computed-Tomography Angiography-Based Carotid Plaque-RADS, Recurrent Vascular Events, and the Effect of Colchicine: An Imaging Substudy of the CONVINCE Randomized Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.