Pearls and Pitfalls of Carotid Artery Imaging: Ultrasound, Computed Tomography Angiography, and MR Imaging

Area of Science:

• Neurology
• Cardiovascular Medicine
• Radiology

Background:

• Stroke is a significant global health burden, with carotid atherosclerosis being a primary cause of ischemic strokes.
• Historically, the degree of carotid artery stenosis was the main indicator of stroke risk.
• Current research emphasizes the structural characteristics of atherosclerotic plaques, leading to the 'vulnerable plaque' concept.

Purpose of the Study:

• To highlight the shift in focus from stenosis degree to plaque characteristics in assessing carotid atherosclerosis.
• To introduce the 'vulnerable plaque' model in the context of stroke risk.
• To underscore the importance of non-invasive imaging for identifying high-risk plaque features.

Main Methods:

• Review of scientific literature over the past 30 years.
• Analysis of the evolution of diagnostic parameters for carotid atherosclerosis.
• Focus on non-invasive imaging modalities for plaque characterization.

Main Results:

• A paradigm shift in understanding carotid atherosclerosis severity, moving from stenosis to plaque morphology.
• Identification of 'vulnerable plaques' as key indicators of stroke risk.
• Demonstration that high-risk imaging features of vulnerable plaques are assessable non-invasively.

Conclusions:

• Early diagnosis and secondary prevention of stroke are critical.
• The 'vulnerable plaque' model offers a more refined approach to risk stratification than stenosis alone.
• Non-invasive imaging plays a crucial role in identifying and managing patients at high risk of stroke due to carotid atherosclerosis.