Computed-Tomography Angiography-Based Carotid Plaque-RADS, Recurrent Vascular Events, and the Effect of Colchicine: An Imaging Substudy of the CONVINCE Randomized Trial
Louise Maes, Anke Wouters, Jo P. Peluso, Jelle Demeestere, Philippe Desfontaines, Adinda De Pauw, Ronan Collins, Dominick J.H. McCabe, Simon Cronin, David J. Williams, Sylvie De Raedt, Francisco Purroy, Geert Vanhooren, George Pope, Peter Vanacker, Tim Cassidy, Darragh Nerney, Cathal Walsh, Daniel Bos, Peter Kelly, Robin LemmensBACKGROUND:
The carotid Plaque Reporting and Data System (Plaque-RADS) provides a standardized framework for evaluating plaque morphology, but prospective validation remains limited. We investigated the association between computed tomography angiography-based Plaque-RADS categories and subsequent ischemic events in patients with noncardioembolic stroke/transient ischemic attack, from a completed clinical trial of colchicine. Second, we assessed whether the effect of colchicine differed by Plaque-RADS risk classification.
METHODS:
We conducted a posthoc observational cohort analysis of 517 participants in the CONVINCE trial (Colchicine for Prevention of Vascular Inflammation in Non-CardioEmbolic Stroke) from 13 European sites. Associations between Plaque-RADS and recurrent ipsilateral stroke, any stroke/transient ischemic attack, and major adverse cardiovascular events were assessed using multivariable Cox proportional hazards models. Plaque-RADS was analyzed as both dichotomized (<3 versus ≥3) and ordinal (per 1-point increase) variables. Treatment effects were assessed by Plaque-RADS classification using interaction and stratified analyses.
RESULTS:
A total of 510 patients (median age, 67.0 years; 72.2% male) with 966 internal carotid arteries were included. Among 321 internal carotid arteries ipsilateral to the index ischemic stroke, 12 recurrent ipsilateral strokes, 32 any strokes/transient ischemic attacks, and 37 major adverse cardiovascular events occurred over a median 35.7-month follow-up. Plaque-RADS ≥3 (n=140) was independently associated with recurrent ipsilateral stroke (adjusted hazard ratio, 7.80 [95% CI, 1.55–39.30];
CONCLUSIONS:
In internal carotid arteries ipsilateral to the index ischemic stroke, computed tomography angiography-based carotid Plaque-RADS was associated with recurrent ischemic stroke and cardiovascular events. Importantly, treatment effects of colchicine varied across Plaque-RADS classification (<3 versus ≥3), suggesting that plaque vulnerability assessment may help refine patient selection for anti-inflammatory therapy beyond stenosis-based classification.
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