Impact of plaque characterization on carotid interventions

Plaque characterization is the first step in a process that will help guide physicians to select patients with atherosclerotic carotid disease that is at risk for subsequent neurologic sequelae. Multiple imaging modalities are undergoing investigation, with B-mode ultrasonography and magnetic resonance imaging showing the most promise for clinical applicability in the near future. These techniques provide excellent characterization of plaque components and appear to correlate with findings at the time of carotid interventions. Magnetic resonance findings may additionally predict transition of asymptomatic carotid plaques into symptomatic lesions. Computed tomography imaging as currently performed does not appear to evaluate plaque components adequately. Whether knowledge of plaque characteristics can be used to impact procedural outcomes remains speculative.