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Study Reveals Plaque Instability, Not Narrowing, Drives Stroke Risk in Mild Carotid Stenosis

The MUSIC study highlights the role of intraplaque hemorrhage and unstable plaque features in stroke risk, challenging current treatment guidelines.

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Overview

  • The MUSIC study found that 81% of patients with symptomatic mild carotid stenosis had unstable plaques, with 59.5% exhibiting intraplaque hemorrhage (IPH).
  • Patients with IPH faced significantly higher risks of recurrent strokes, even when receiving best medical therapy.
  • Carotid endarterectomy (CEA) reduced the two-year ischemic stroke rate to 1.7%, compared to 15.1% in patients managed with medical therapy alone.
  • The findings challenge existing guidelines that reserve CEA for moderate to severe stenosis, advocating for advanced imaging to assess plaque composition.
  • Researchers call for further studies to validate these results across diverse populations and explore adjunctive therapies targeting plaque stabilization.