Unstable carotid artery plaque: new insights and controversies in diagnostics and treatment
Karolina Skagen1, Mona Skjelland, Mahtab Zamani
1Karolina Skagen, Oslo University Hospital, Rikshospitalet, Nevrologisk poliklinikk, Postbox 4950 Nydalen, 0424 Oslo, Norway, kskagen@ous-hf.no.
Insights
Cardiovascular disease causes 14 million deaths annually. New methods identify unstable carotid plaques, improving stroke risk prediction beyond traditional factors for better prevention strategies.
Area of Science:
- Cardiology
- Neurology
- Vascular Surgery
Background:
- Cardiovascular disease is the leading global cause of death, with stroke being a major public health concern.
- Thromboembolic events from carotid artery atherosclerosis account for a significant portion of ischemic strokes.
- Current stroke risk assessment relies on general patient characteristics and static stenosis measures, which are insufficient for individual risk prediction.
Purpose of the Study:
- To review emerging methods for identifying carotid plaque instability.
- To explore new approaches for assessing stroke risk in patients with carotid stenosis.
- To enhance individual patient risk stratification for stroke prevention.
Main Methods:
- Review of current literature on carotid plaque imaging and characterization.
- Analysis of novel diagnostic techniques for plaque vulnerability assessment.
- Synthesis of data on the correlation between plaque instability and stroke events.
Main Results:
- Traditional risk factors and degree of stenosis alone do not accurately predict stroke risk.
- Carotid plaque instability is a critical factor in determining thromboembolic events.
- Emerging methods offer improved identification of high-risk plaques.
Conclusions:
- Accurate stroke risk assessment requires evaluating carotid plaque characteristics beyond stenosis degree.
- Identifying carotid plaque instability is crucial for targeted stroke prevention strategies.
- New assessment methods promise more personalized and effective stroke risk management.
Abstract:
Cardiovascular disease is estimated to be the leading cause of death, globally causing 14 million deaths each year. Stroke remains a massive public health problem and there is an increasing need for better strategies for the prevention and treatment of this disease. At least 20% of ischemic strokes are thromboembolic in nature, caused by a thromboembolism from an atherosclerotic plaque at the carotid bifurcation or the internal carotid artery. Current clinical guidelines for both primary and secondary prevention of stroke in patients with carotid stenosis caused by atherosclerotic plaques remain reliant on general patient characteristics (traditional risk factors for stroke) and static measures of the degree of artery stenosis. Patients with similar traditional risk factors, however, have been found to have different risk of stroke, and it has in recent years become increasingly clear that the degree of artery stenosis alone is not the best estimation of stroke risk. There is a need for new methods for the assessment of stroke risk to improve risk prediction for the individual patient. This review aims to give an overview of new methods available for the identification of carotid plaque instability and the assessment of stroke risk.
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