💬 Editorial: Stroke risk classification that relies solely on carotid stenosis severity overlooks patients with nonobstructive but high-risk carotid plaques, underestimating the true contribution of carotid disease to ischemic stroke.

Recent European Society of Cardiology guidelines and Carotid Plaque–RADS offer improved risk stratification by accounting for plaque features, with evidence showing significant gains in predictive accuracy.

This Viewpoint argues that risk classification in ischemic stroke should be expanded beyond stenosis severity to encompass other complementary features, such as plaque morphology, composition, and inflammation.