For people after a stroke or high-risk mini-stroke who have plaque in a neck artery: what a standardised plaque score added to the usual measure of narrowing, what a post hoc look suggested about anti-inflammatory treatment, and why it is still a hypothesis.
On 22 October 2026 the journal Stroke published a new analysis from CONVINCE, a randomised trial of long-term colchicine, an anti-inflammatory drug, in hospital patients after a non-severe ischaemic stroke or a high-risk transient ischaemic attack (TIA) not caused by a clot from the heart. In this post hoc analysis the researchers used CT angiography (contrast CT scans of the neck arteries) to grade 966 internal carotid arteries of 510 participants from 13 European sites, median age 67, 72% of them men, with Plaque-RADS. This scale, proposed by an expert panel in JACC: Cardiovascular Imaging in 2024, runs from 1 (no plaque) to 4 (complicated plaque) and describes what a plaque looks like rather than only how much it narrows the artery.
In these patients, high scores went with more repeat events
Over a median follow-up of 35.7 months there were 12 repeat strokes on the same side as the first one, 32 strokes or TIAs of any kind and 37 major cardiovascular events. A score of 3 or higher in the artery on the side of the stroke (the abstract gives n = 140) was linked to more of all three, after adjustment for age, sex and cardiovascular risk factors: the hazard ratio was 7.80 for a repeat stroke on that side, 3.94 for any stroke or TIA and 2.52 for major cardiovascular events. With only 12 same-side strokes the first figure is very imprecise; its 95% confidence interval runs from 1.55 to 39.30.
The drug's apparent effect depended on the plaque
The main CONVINCE results, published in The Lancet in 2024, covered 3,144 hospital patients after a non-severe, non-cardioembolic ischaemic stroke or high-risk TIA. In them, adding colchicine to usual care did not significantly reduce the combined primary outcome of repeat ischaemic stroke, heart attack, cardiac arrest or hospital admission for unstable angina: 9.8% against 11.7% (hazard ratio 0.84; 95% CI 0.68 to 1.05). The trial ended before reaching its planned number of events because of budget limits linked to the COVID-19 pandemic. In the new analysis, the effect of colchicine on major cardiovascular events differed by plaque score (test for interaction p = 0.047): among patients with a score of 3 or higher the hazard ratio was 0.35 (95% CI 0.15 to 0.82). The abstract does not give the estimate for lower scores.
One slice of one trial, looked at afterwards
This is a post hoc observational analysis of 510 of the 3,144 CONVINCE participants, the event counts are small, and the interaction p-value was 0.047. CONVINCE itself was open-label, with outcomes judged by assessors who did not know the treatment. A larger trial in a different setting found no effect: in CHANCE-3, published in The BMJ in 2024, 8,343 patients aged 40 or older in China with an acute non-cardioembolic minor-to-moderate stroke or TIA and high-sensitivity C-reactive protein of at least 2 mg/L received colchicine or placebo for 90 days, and new strokes occurred in 6.3% and 6.5% (hazard ratio 0.98; 95% CI 0.83 to 1.16). The abstract of the new paper does not say who funded the substudy; the main trial reports funding from the Health Research Board Ireland, the Deutsche Forschungsgemeinschaft and the Fonds Wetenschappelijk Onderzoek Vlaanderen.
The authors conclude that assessing how vulnerable a plaque looks may help refine who is offered anti-inflammatory treatment, beyond the degree of narrowing. A post hoc analysis cannot establish that; it would take a trial designed for this question. Until then the practical point is narrower: if a scan after a stroke or TIA has shown plaque in a neck artery, it makes sense to ask the neurologist how the plaque itself was described, not only by what percentage it narrows the vessel, and whether these results apply to you. Whether any anti-inflammatory treatment is right for you is a question to discuss with your doctor.
This material is for information only and does not replace a consultation with a doctor.
Sources
Maes L, Wouters A, Peluso JP, et al. Computed-tomography angiography-based carotid Plaque-RADS, recurrent vascular events, and the effect of colchicine: an imaging substudy of the CONVINCE randomized trial. Stroke. 2026. PMID 42910427 · DOI 10.1161/STROKEAHA.126.057740
Kelly P, Lemmens R, Weimar C, et al. Long-term colchicine for the prevention of vascular recurrent events in non-cardioembolic stroke (CONVINCE): a randomised controlled trial. Lancet. 2024;404(10448):125-133. PMID 38857611 · DOI 10.1016/S0140-6736(24)00968-1
Saba L, Cau R, Murgia A, et al. Carotid Plaque-RADS: a novel stroke risk classification system. JACC: Cardiovascular Imaging. 2024;17(1):62-75. PMID 37823860 · DOI 10.1016/j.jcmg.2023.09.005
Li J, Meng X, Shi FD, et al. Colchicine in patients with acute ischaemic stroke or transient ischaemic attack (CHANCE-3): multicentre, double blind, randomised, placebo controlled trial. BMJ. 2024;385:e079061. PMID 38925803 · DOI 10.1136/bmj-2023-079061
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