Carotid artery disease and stroke: assessing risk with vessel wall MRI

Area of Science:

• Neurology
• Radiology
• Cardiovascular Medicine

Background:

• Carotid artery stenosis is a known stroke risk factor.
• Magnetic resonance imaging (MRI) is a standard diagnostic tool for carotid stenosis.
• Atherosclerotic plaque characteristics are increasingly recognized as important for stroke risk stratification.

Purpose of the Study:

• To review the current evidence for the clinical utility of MRI in evaluating carotid atherosclerosis.
• To highlight the role of plaque characteristics (size, composition, activity) detected by MRI as stroke risk factors.

Main Methods:

• Literature review of studies utilizing MRI for carotid atherosclerosis assessment.
• Analysis of evidence linking MRI-derived plaque features to clinical outcomes, particularly stroke.

Main Results:

• MRI can non-invasively assess carotid plaque size, composition (e.g., lipid core, fibrous cap, intraplaque hemorrhage), and activity (e.g., inflammation).
• These plaque features identified by MRI are independent predictors of cerebrovascular events.
• MRI findings offer incremental prognostic information beyond traditional stenosis grading.

Conclusions:

• MRI provides valuable information on carotid plaque characteristics beyond luminal stenosis.
• Assessing plaque composition and activity with MRI can refine stroke risk prediction.
• Further clinical integration of MRI for carotid atherosclerosis holds promise for personalized stroke prevention strategies.