Clinical Research Directory

Inclusion Criteria: 1. Age ≥ 40 and ≤ 80 years 2. Recently symptomatic (TIA, amaurosis fugax, or non-disabling ischaemic stroke with mRS ≤ 2) referable to a carotid territory within 28 days of randomisation 3. Ipsilateral extracranial internal carotid artery stenosis of 50-69% by NASCET criteria on CTA or DSA 4. HR-VW-MRI evidence of IPH (MPRAGE hyperintensity ≥150% of adjacent sternocleidomastoid) OR LRNC ≥ 10% of plaque volume in the symptomatic plaque 5. On a stable dose of high-intensity statin (atorvastatin 40-80 mg or rosuvastatin 20-40 mg) for ≥ 4 weeks, or able and willing to initiate atorvastatin 80 mg daily at randomisation 6. LDL-C ≥ 70 mg/dL (1.8 mmol/L) at screening 7. Able to undergo 3T MRI (no contraindications) 8. Provides written informed consent Exclusion Criteria: 1. Indication for urgent carotid revascularisation within 14 days per treating team 2. Disabling stroke (mRS \> 2) or NIHSS \> 5 at randomisation 3. Carotid stenosis ≥ 70% or occlusion 4. Cardioembolic stroke source (atrial fibrillation, LV thrombus, endocarditis, PFO with high-risk features) 5. Intracranial haemorrhage within 12 months or any history of symptomatic ICH 6. eGFR \< 30 mL/min/1.73 m² 7. Active hepatobiliary disease or ALT/AST \> 3x ULN 8. Prior exposure to any PCSK9 inhibitor or inclisiran within 6 months 9. Known hypersensitivity to alirocumab or excipients 10. Pregnancy, breastfeeding, or unwillingness to use contraception in women of childbearing potential 11. Life expectancy \< 24 months 12. Participation in another interventional trial within 30 days 13. Inability to comply with follow-up or MRI schedule