搜索结果：Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese

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The concept of mitral annular disjunction (MAD) has garnered significant attention due to its potential clinical implications. MAD refers to a spatial displacement of the hinge point of the mitral valve leaflets. Initially described over 150 years ago, MAD has evolved from being an anatomical curiosity to a potential marker of pathological processes, especially in the context of mitral valve prolapse and arrhythmic syndromes. Two distinct types of MAD can be identified: atrial (a-MAD), characterized by annular displacement toward the left atrium, and ventricular (v-MAD), characterized by annular displacement toward the left ventricle. The prevalence of a-MAD varies based on the patient population studied, the imaging techniques employed, and the specific definition of a-MAD used and ranges from 7.2%-8.7%-96.0%. The prevalence of v-MAD is approximately 25%. It is critical to note that disjunction is non-uniformly distributed around the circumference of the junction supporting the mural leaflet of the valve and is also present in the commissural areas, interspersed with alternating segments of tissue that do not exhibit disjunction. Clinically, a-MAD may be associated with mitral valve prolapse, ventricular arrhythmias, and sudden cardiac death, underscoring its importance in risk stratification and management. V-MAD, although less studied, raises intriguing possibilities about its role in mitral valve dynamics and its possible contribution to pathological processes. Through a detailed review of existing literature and clinical observations, this article seeks to elucidate the spectrum of MAD's presentations, its diagnostic challenges, and its potential impact on patient outcomes.

Current European guidelines for primary atherosclerotic cardiovascular disease (ASCVD) prevention recommend using Systematic Coronary Risk Evaluation 2 (SCORE2) algorithms for risk classification and decision-making. For the Greek population, an updated model - HellenicSCORE II+ - has been developed. This cross-sectional study compared SCORE2 versus HellenicSCORE II+ in detecting preclinical carotid atherosclerosis. Middle-aged (40-69 years) individuals from the general population without ASCVD, were invited to participate on a voluntary basis in screening programs in 3 municipalities of Attica, Greece (2023-2025). Handheld carotid ultrasonography was performed and carotid plaque score (CPS) was calculated by summing points allocated to the number/height of plaques. A total of 965 individuals were analyzed [mean age 57.1&#xb1;8.0 (SD) years, men 43.2%, body mass index 27.6&#xb1;4.7 kg/m2, smokers 27.8%, diabetes 7%, antihypertensive/lipid-lowering drug treatment 41.6%/46.5% respectively, SCORE2 5.2&#xb1;3.4%, HellenicSCORE II+ 3.7&#xb1;2.4%]. Participants classified as low-moderate/high/very-high ASCVD risk were 50.9%/43.3%/5.8% according to SCORE2, 74.4%/23%/2.6% with HellenicSCORE II+ and 55.6%/36.4%/8% with CPS. The agreement between SCORE2 and HellenicSCORE II+ was 67.2% (kappa 0.37, P<0.01), whereas between CPS and SCORE2/HellenicSCORE II+ 57.6%/56.2% (kappa 0.24/0.13, P<0.01 for each, P<0.01 for comparison). Receiver operating characteristic curve analysis demonstrated similar discrimination of SCORE2/HellenicSCORE II+ for detecting carotid atherosclerosis (AUC 0.74, 95% confidence intervals 0.71-0.78 and 0.71, 0.68-0.74 respectively, P=NS for comparison). SCORE2 classified a higher proportion of participants as high/very-high ASCVD risk compared with HellenicSCORE II+. Both models demonstrated moderate discrimination for detecting carotid plaque burden, highlighting the need for carotid imaging in refining ASCVD risk.

IL-1 blockade marks an important step forward in the management of recurrent pericarditis who that do not respond to conventional therapies. However, it is not known why a considerable percentage of patients experience recurrence during drug tapering, necessitating maintenance therapy for prolonged periods. A prospective observational cohort study was conducted at a tertiary referral centre, enrolling all consecutive adult patients with recurrent pericarditis treated with anakinra. Whole exome sequencing was used to identify genetic disease associated variants. Seventy-six patients were treated with anakinra, of these 20 patients (26.3%) had genetic variants associated with pericarditis. characteristics were similar between the two groups, except for a higher frequency of fever (80.0 vs 55.4%, p=0.038) in the genetic group. After a mean follow-up of 30 [24-41] months, patients with genetically determined associated pericarditis exhibited a significantly higher percentage of recurrence (80.0% vs 41.1%, p=0.003), shorter time to first recurrence (p<0.0001) and a lower possibility to discontinue anakinra (p =0.044). Genetics remained an independent predictor of poor outcome even after multivariate analysis, conferring an approximately 4-fold increased risk of recurrence (HR 4.069, 95%CI: 2.092 to 7.913, p<0.001), and 8-fold increased risk of failing to discontinue anakinra (HR 0.120, 95%CI: 0.027 to 0.521, p=0.005). In this cohort of recurrent pericarditis treated with anakinra approximately one in four patients showed a genetic predisposition. These patients exhibited a higher percentage of recurrence, shorter time to first recurrence and a lower possibility to discontinue anakinra highlighting the prognostic impact of genetic testing in patients treated with anti IL-1 agents.

This systematic review and meta-analysis aimed to determine the prevalence and clinical relevance of main coronary artery (CA) origin and course anomalies (class A variations) in healthy populations. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 and Evidence-based Anatomy guidelines. A literature search was conducted across PubMed, Google Scholar, Scopus, and Web of Science. Statistical analysis was performed in R using random-effects models, with pooled prevalence calculated through the Freeman-Tukey transformation. Subgroup, meta-regression, and leave-one-out analyses were performed to explain the source of heterogeneity. A total of 58 studies with 503,171 subjects were included. The pooled prevalence of typical CA anatomy was 97.89% (95% CI: 97.51-98.25), whereas main CA anomalies had a prevalence of 2.11% (95% CI: 1.82-2.70). Subgroup analysis retrieved statistically significant differences for nationality and study type, and meta-regression revealed an increasing trend of CA variants with later publication years. The most common variation was the anomalous origin of the right CA from the left sinus (0.30%), followed by a high take-off of the right CA (0.14%). Left CA anomalies were less frequent, with anomalous origin from the right sinus recorded in 0.05% of cases. Subgroup analyses revealed a higher prevalence in American populations and computed tomography-based studies. Main CA anomalies (class A variations) are rare but clinically significant owing to their association with ischemic events and sudden cardiac death, particularly variants with interarterial or intramural courses. Early identification through modern imaging is critical for risk stratification and clinical decision-making.

Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disorder and a major cause of sudden cardiac death in young adults and competitive athletes. Distinguishing HCM from exercise-induced physiological hypertrophy is clinically critical, particularly, within the diagnostic "gray zone," where morphological and functional parameters overlap. Artificial intelligence (AI), including machine learning (ML) and deep learning, has emerged as a methodological framework for extracting latent diagnostic information from complex cardiovascular data sets. However, the extent of its validated application in differentiating HCM from athlete's heart remains unclear. A scoping review was conducted according to the Arksey and O'Malley methodology and PRISMA-ScR guidelines. Four electronic databases (PubMed, Scopus, Web of Science, IEEE Xplore) were searched (up to October 2025) for primary studies using AI/ML to discriminate HCM from physiological or other etiologies of left ventricular hypertrophy. Inclusion criteria required confirmed HCM populations, use of AI analytical methods, and reporting of diagnostic performance metrics. Data extraction focused on population source, data modality, model architecture, performance indexes, and presence of athlete-specific cohorts. Eight studies met the inclusion criteria. Only one directly compared HCM with athlete's heart, using deformation-derived echocardiographic parameters and support vector machine classification (AUC 0.93). The remaining studies examined HCM versus hypertensive or non-pathological hypertrophy using ECG-, echocardiography-, radiomics-, or video-based AI analysis, demonstrating AUC values between 0.89 and 0.96. No recent athlete-specific data sets were identified. AI shows strong potential to enhance the differential diagnosis of HCM through advanced imaging and ECG pattern analysis. However, the paucity of athlete-derived data sets and limited external validation significantly constrain clinical applicability in sports cardiology. Future research should prioritize explainable, multimodal models and dedicated athlete cohorts.

Despite increasing female participation in medicine, gender disparities persist in cardiology and cardiac surgery globally. In Greece, data on gender disparities in these specialties have been limited. This study aimed to systematically investigate the professional experiences, perceived barriers, and career development challenges faced by women cardiologists and cardiac surgeons in Greece. A national, cross-sectional survey was distributed electronically to all female members of the Hellenic Society of Cardiology and the Hellenic Society of Thoracic and Cardiovascular Surgeons. The 47-item questionnaire captured demographic, academic, and professional data, including perceptions of gender-related bias, leadership representation, and work-life integration. Among 743 recipients, 243 women responded (response rate: 33%). Although 47% held an MSc, 39% a PhD, and over 55% a subspecialization, only 3.8% occupied academic positions. Most participants reported prioritizing maternal responsibilities over their careers (78%) and considered their gender a barrier to career progression (64.7%). Gender-based discrimination and workplace bullying were reported by 58.7%, and 49.6% indicated patient mistrust. Only 27.5% believed they had equal career advancement opportunities, and only 21.2% felt equally represented in research leadership. Representation in national scientific societies and academic leadership remains markedly low, consistent with European data, with only a few female heads of cardiology departments in Greece. Women cardiologists and cardiac surgeons in Greece face multifaceted and deeply entrenched structural barriers despite high levels of qualification. These findings call for urgent policy, institutional, and cultural reforms to advance gender equity in cardiovascular medicine and surgery.

Left ventricular hypertrophy (LVH) is classified as concentric or eccentric based on left ventricle relative wall thickness. Using machine learning techniques on basic clinical parameters and features from a single-lead electrocardiogram (ECG), we detected LVH in a hypertensive population without cardiovascular disease. We enrolled 812 subjects with hypertension with no indications of cardiovascular disease. Based on left ventricular mass index and relative wall thickness, the subjects were classified into two groups; i) normal geometry and concentric remodeling were classified as no-LVH, whereas ii) concentric and eccentric hypertrophy were classified as having LVH. We trained a Random Forest to distinguish between the two categories. For comparison, we also trained a logistic regression and a convolutional neural network model. We performed feature importance and interaction analysis using SHAP to interpret the model's predictions for feature importance and feature interactions. Our model was able to distinguish subjects with no-LVH from the ones with LVH, with an ROC/AUC of 0.82 (95% CI: 0.71-0.91) and an average precision of 0.61. At threshold 0.3, specificity is 81% and sensitivity is 58%. Age, corrected QT interval, T wave duration, and being female were the most important features that contributed to the model's predictions. Using an analysis of single-lead ECG combined with clinical data, we demonstrated strong performance in detecting LVH. The identification of key ECG features, such as corrected QT interval and T wave morphology, underscores the clinical value of single-lead ECG analysis. These findings are particularly important in the era of wearable devices, where accessible, noninvasive screening for cardiac conditions such as LVH can be integrated into everyday health monitoring.

Mitral regurgitation (MR) represents the most common valvular heart disease in Western industrialized nations. In addition to degenerative MR (dMR) and functional MR (fMR), there has been a notable increase in the prevalence of atrial functional MR (a-fMR), which has led to the renaming of fMR as ventricular functional MR (v-fMR). To date, conflicting evidence exists regarding long-term outcomes according to MR etiology after transcatheter edge-to-edge mitral valve repair (mTEER). All mTEER patients from four heart centers whose echocardiographic data were available were retrospectively analyzed. After adjustment for confounders by propensity score matching (PSM), we analyzed long-term survival after mTEER according to MR etiology via the Kaplan-Meier method. Of the 554 patients who met the inclusion criteria, 35.4% had dMR (196/554), 48.4% had v-fMR (268/554), and 16.2% had a-fMR (90/554). The a-fMR patient group had the highest mean age and the highest proportion of female patients. A predisposition to minor bleeding events was observed among patients with a-fMR, while the overall safety profile was comparable to that of patients with other MR etiologies. The long-term survival of patients with v-fMR was significantly worse than that of patients with dMR after PSM (52.1% [102/196] vs. 65.9% [129/196], p = 0.03). No major difference in long-term survival was observed between patients with a-fMR and those with dMR (61.2% [55/90] vs. 68.2% [61/90], p = 0.8). Patients with v-fMR had the poorest long-term survival among the three cohorts. We did not observe any relevant difference in the adjusted long-term survival of patients with a-fMR compared with patients with other MR etiologies.

Data on the characteristics and outcomes of patients with hematologic cancers undergoing cardiovascular (CV) admissions in real-world settings are limited. This study used data from the National Inpatient Sample (2016-2020), including all CV admissions. Patients were stratified based on the presence of hematologic cancers and their subtypes. The primary outcome was the cause of CV admission, and the secondary outcome was all-cause mortality. Descriptive statistics and multivariable logistic regression (adjusted odds ratios [aOR]) were used to compare outcomes across groups. Of 5,957,492 CV admissions, 78,670 (1.3%) patients were admitted with hematologic cancer. These patients were older (median age 75 vs. 70-72 years) and had a higher prevalence of comorbidities such as atrial fibrillation, thrombocytopenia, anemia, congestive heart failure, valvular disease, coagulopathy, and chronic renal failure, compared with patients with other cancer and those without cancer. Hypertension was the most common cause of CV admission (30.7% vs. 20.4-27.3% in others), followed by atrial fibrillation/flutter and heart failure/valve disorders. In-hospital mortality was higher in patients with hematologic cancer, especially for chronic ischemic heart disease (aOR 2.35, 95% CI 1.90-2.91, p < 0.001). Within hematologic cancers, acute hemorrhagic stroke had the highest mortality, particularly, in leukemia (28.7% vs. 25.3-26.5%, p < 0.001). Patients with hematologic cancers admitted with a CV cause exhibit distinct patterns of CV admission causes, with hypertension, atrial fibrillation, and heart failure being the most common, and experience higher mortality than patients without cancer during CV admissions.

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Although cross-over stenting (CS) remains the gold standard for treating most bifurcation lesions, ostial stenting (OS) may be considered for patients with favorable anatomy. The aim of this study was to evaluate outcomes after OS vs. CS in patients with 0.1.0 and 0.0.1 bifurcation lesions. A total of 790 patients who underwent PCI for 0.1.0 and 0.0.1 lesions and had clinical follow-up were included in the analysis. The patients were divided into an OS group (n = 186) and CS group (n = 604). An inverse probability treatment weighting model was used to assess long-term outcomes. OS was more often performed in patients with left main disease (52% vs. 31%, p < 0.001). Patients in the OS group more often had calcification (23% vs. 15%, p = 0.026) and thrombosis (11% vs. 6.5%, p = 0.044). The occurrence of residual dissection was significantly lower in the OS group (0.2% vs. 3.1%, p = 0.007) in addition to disturbance of blood flow in the SB after stent implantation (0.5% vs. 3.2% p = 0.007). The median follow-up was 1504 days. There were no significant differences in the major adverse cardiac events (MACE) between groups (18.9% vs. 22.2%, p = 0.331). However, a lower rate of target vessel revascularization (TVR) was observed in the OS group (2.4% vs. 0.5%, p = 0.046). In patients with 0.0.1 and 0.1.0 bifurcation lesions, OS was associated with less residual stenosis and lower incidence of blood flow disturbance in the SB after stent implantation, and a lower incidence of TVR at follow-up than was the CS, but this finding was not accompanied by a reduction in the rates of MACE.

Ultra-processed foods (UPFs) are industrial products formulated largely from extracted or refined food constituents, such as sugars, starches, oils, and protein isolates, and typically contain additives (e.g., flavorings, colorants, emulsifiers, sweeteners, and preservatives) to improve taste, appearance, and shelf stability. UPFs are often energy-dense, high in added sugars, unhealthy fats, and sodium, and low in dietary fiber and essential micronutrients. High intake has been consistently linked to increased risks of obesity, cardiovascular disease (CVD), type 2 diabetes, and all-cause mortality. The cardiovascular health implications of UPF consumption remain incompletely understood. This position review aims to synthesise current evidence on associations between UPF intake and CVD and to survey the positions of major scientific organisations regarding UPF and cardiovascular health. Given substantial heterogeneity in UPF definitions, exposure assessment, cardiovascular outcomes, and study designs, a position review approach is appropriate to characterise how this relationship has been examined to date.

Although high sodium intake is a well-established risk factor for cardiovascular disease, its specific association with prediabetes remains unclear, particularly, in Asian populations. We aimed to investigate the association between dietary sodium intake and prediabetes prevalence in a large-scale Korean cohort. This cross-sectional study analyzed 57,165 adults without diabetes from the Korea National Health and Nutrition Examination Survey 2010-2018. Dietary sodium was assessed via a 24-h recall. We evaluated associations using multivariable-adjusted odds ratios (ORs) across sodium octiles and the World Health Organization (WHO) threshold (&#x2265;2.0 g/day, salt &#x2265;5.1 g/day). Restricted cubic splines (RCS) were used to characterize dose-response patterns. Prediabetes prevalence rose from 22.9% in the lowest sodium octile (&#x2264;1.4 g/day) to 33.3% in the highest (>6.2 g/day). Using the WHO threshold, sodium intake &#x2265;2.0 g/day was associated with greater odds of prediabetes (crude OR 1.417, 95% CI 1.357-1.479; p < 0.001), which remained significant after adjustment for age, sex, body mass index, and clinical risks (hypertension, dyslipidemia, stroke, myocardial infarction, angina pectoris, renal failure, thyroid disease, cancer, and current smoking) (OR 1.151, 95% confidence interval [CI] 1.093-1.212; p < 0.001). RCS analysis identified a significant non-linear dose-response pattern (p-nonlinearity <0.01), where risk peaked at approximately 3-4 g/day of sodium (7.6-10.2 g/day salt). Sensitivity analysis showed this association was independent of potassium intake (R = 0.63). Subgroup analysis by body mass index revealed divergent patterns, with a nearly linear increase in the underweight group and a U-shaped trend in the overweight group. Annual trends (2010-2018) showed a significant decline in median sodium intake from 3.8 g/day to 2.7 g/day (p-trend <0.001). Higher dietary sodium intake is independently associated with an increased prevalence of prediabetes in Korean adults. The observed risk threshold and dose-response plateau suggest that sodium moderation, specifically, aiming below the 3-4 g/day range, may be a vital strategy for preventing glycemic dysregulation alongside blood pressure control.

Cardiac intensive care units (CICUs) have evolved to manage increasingly complex cardiovascular illnesses, yet national level data on infrastructure, staffing and advanced support in Greece are limited. The aim of this nationwide survey was to map CICUs in Greece. The survey questionnaire was distributed to hospitals of the national health system across the country. Of 81 hospitals, 74% reported the presence of a general ICU, 25% an intermediate care unit, and 70% had a dedicated CICU. Among 57 CICUs, 53% operated with 6-10 beds; hospital bed number and tertiary hospital type were independent predictors of CICU bed number. Nursing coverage was in most CICUs at least 1 nurse per 3 patients (1:3) in the morning shift (72%) with declining percentages of 1:3 ratio in the afternoon (47%) and night (44%) shift. A nurse-to-patient ratio less than 1:4 was frequent in the afternoon (32%) and night (37%) shifts even in CICUs in tertiary centres. Staffing with a cardiologist-intensivist was observed in only 21% of all CICUs (24% in tertiary centres). Respiratory support (non-invasive/invasive: 95%/89%) was widely available. Availability of continuous-renal-replacement-therapy (odds ratio [OR]:3.9; p=0.019), Swan-Ganz use (OR:11.2; p=0.010), intra-aortic balloon pump (OR:14.2; p<0.001) and tracheotomy (OR:3.6; p=0.043) was more frequent in CICUs in tertiary centres. The survey demonstrated potential actionable items for improvement including an increase in nurse-to-patient ratios and cardiovascular intensivists in CICUs in Greek public hospitals. Aligning the operation/staffing of CICUs with international standards could be considered for advancing acute/critical cardiac care on a nationwide level.

Pacing-induced cardiomyopathy (PiCM) significantly impacts patient morbidity and mortality, emphasizing the need for improved preventive and therapeutic strategies. This systematic review aimed to evaluate the effectiveness of resynchronization therapies compared with traditional right ventricular pacing (RVP). Emerging evidence supports the use of biventricular cardiac resynchronization therapy (BiV-CRT) and conduction system pacing (CSP) as effective alternatives to conventional RVP. Both strategies preserve ventricular synchrony, improve left ventricular (LV) function, and reduce adverse outcomes. Comparative studies suggest superior physiological and clinical benefits of CSP over BiV-CRT, including greater improvements in QRS duration, LV ejection fraction (LVEF), and functional status. In addition, pharmacological therapy-particularly, combination ACEi/ARB with &#x3b2; blockers-has shown potential in reducing the incidence of PiCM. We conducted a systematic review (inception to August 2025), including 22 studies (2 randomized trials, 20 observational) which met inclusion criteria. BiV-CRT and CSP significantly improved LVEF and NYHA class, with CSP demonstrating incremental advantages in selected cohorts. Preventive approaches, especially CSP and medical therapy, lowered PiCM incidence in high-risk patients with elevated pacing burden. Despite these advances, heterogeneity in PiCM definitions, patient selection, and follow-up durations limit cross-study comparability. Future research should focus on standardizing diagnostic criteria, refining risk stratification, and developing individualized algorithms that integrate device-based and pharmacological strategies for optimal PiCM prevention and management.

Statistical models used to estimate the cardiovascular disease (CVD) risk often present methodological constraints leading to overestimate or underestimate the total CVD risk. The aim of this study was to develop and implement a web-based Machine Learning (ML) platform to predict the personalized 10-year CVD risk for the Greek population. The retrospective study included clinical and demographic data from 3,290 CVD-free participants. The CVD risk prediction model was based on two classifiers. The first was a binary classifier to estimate the occurrence of CVD, and the second was a multiclass classifier designed to replicate SCORE2 risk stratification categories. The selection of appropriate algorithms for integration into the platform was based on the evaluation metric ROC-AUC. To support the clinicians, the platform was integrated with scientific libraries to retrieve the most relevant literature based on the features that most influence the model decision-making. The Voting Ensemble algorithm was selected for the binary classifier, achieving an AUC-ROC of 0.78. For the multiclass classifier, the selection algorithm was Stacking Ensemble, which yielded a 0.97 AUC-ROC. The comparison between ML and statistical model HellenicScore showed that the binary classifier was better in all metrics except accuracy in which HellenicSCORE had a higher value. The CVD risk prediction model and the integration with scientific libraries were successfully developed and deployed as a web-based platform. The pilot run of the platform showed that it could be used as a reliable tool for CVD risk assessment, outperforming the traditional statistical models.

Transthyretin cardiac amyloidosis (ATTR) is prevalent among patients undergoing transcatheter aortic valve implantation (TAVI) for severe aortic stenosis (AS). We aimed to develop and validate a risk score for predicting ATTR in this context. In the prospective multicentre GRECA-TAVI registry, 500 patients with severe AS scheduled for TAVI were screened for ATTR using technetium-99m-labeled DPD or PYP bone scintigraphy in 12 tertiary hospitals, from January 1st to December 31st, 2024. Clinical, echocardiographic, and electrocardiographic variables were recorded. A logistic regression-derived integer-based risk score was developed in a training cohort (n=350) and validated in a validation cohort (n=150). Model performance was evaluated using discrimination, calibration, and decision curve analyses. ATTR was diagnosed in 38 patients (7.6%). Five variables (age, sex, MWT, LVEF, and intracardiac device presence) formed the basis of an 8-point risk score. The score demonstrated good discrimination (AUC=0.75 training, 0.76 validation) and calibration (slope=1.15). A score &#x2265;4 identified patients with a &#x223c;16% ATTR prevalence compared to 2.4% in those with a score <4. This threshold captured most of the ATTR cases (73%) while recommending screening for only 36% of the cohort. Decision curve analysis showed net clinical benefit across clinically relevant thresholds (5-20%) over and above a guideline-recommended approach (based on MWT&#x2265;12mm) or a screen-all strategy. ATTR is common in patients with severe AS undergoing TAVI. A simple bedside score using routinely available variables effectively identifies those patients at risk for ATTR. Selective screening using this tool could improve diagnostic yield and resource allocation.

Ischemic strokes remain a leading cause of mortality and morbidity worldwide. Carotid artery stenosis is a major risk factor for ischemic strokes. Although traditional carotid revascularization procedures are based on carotid stenosis, it has been increasingly recognized that plaque composition plays an important role in plaque rupture and stroke occurrence. Our narrative review aims to present the evidence related to 1) carotid atherosclerosis and plaque composition contributors to stroke and 2) medical management and revascularization of patients with carotid artery stenosis for stroke prevention. For patients with severe carotid atherosclerosis, critical treatment modalities include best medical therapy and revascularization, specifically, carotid endarterectomy (CEA) or carotid artery stenting (CAS) for symptomatic and asymptomatic individuals, according to stenosis guidelines (&#x2265;50% and &#x2265;70% stenosis, respectively). Landmark randomized controlled trials (RCTs) showcased the clinical value of surgery in reducing future stroke outcomes for asymptomatic and symptomatic populations. Along with the latest advancements in medical therapy, results from modern RCTs are providing much needed evidence regarding the net benefits in revascularization for stroke risk reduction, namely, in asymptomatic populations. Evidence suggests that carotid artery stenosis, the primary metric for CEA or CAS eligibility is not always consistent with the degree of plaque instability. We emphasize the importance of combining plaque instability and carotid stenosis assessments to better classify at-risk patients. Along with integrations of interventions with modern medical treatment, novel findings from RCTs and consideration of stenosis and plaque instability will ultimately help improve individualized care leading to effective prevention of ischemic strokes.