Advanced carotid plaque imaging.

Area of Science:

• Vascular Medicine
• Molecular Imaging
• Radiology

Background:

• Carotid artery stenosis treatment decisions often rely on stenosis degree, but plaque vulnerability is crucial for stroke risk prediction.
• Molecular processes like inflammation, lipid accumulation, and apoptosis contribute to plaque vulnerability.
• Identifying these molecular processes is key to refining treatment strategies.

Purpose of the Study:

• To review advanced imaging techniques for identifying pathophysiological processes in carotid artery stenosis.
• To highlight promising molecular and functional imaging strategies for vulnerable plaque detection.
• To discuss the role of these techniques in patient selection for carotid interventions.

Main Methods:

• Literature review of advanced imaging modalities including high-resolution magnetic resonance imaging (HR-MRI), SPECT, PET, and NIRF.
• Focus on radionuclide and fluorescent tracers targeting inflammation, apoptosis, and proteolysis (e.g., FDG, MMP probes, Annexin A5).
• Integration of molecular activity data with anatomical information.

Main Results:

• Advanced imaging techniques offer insights into molecular processes within carotid plaques.
• Tracers targeting inflammation and apoptosis show promise for identifying vulnerable plaques.
• Combining molecular imaging with anatomical data provides a comprehensive assessment of plaque risk.

Conclusions:

• Advanced imaging represents a new era in the evaluation of carotid artery disease.
• These techniques can significantly enhance the identification of patients at high risk for stroke.
• Improved patient selection for endarterectomy or stenting will be facilitated by molecular imaging.