Impact of Plaque Analysis on Treatment Strategy Marco A Costa and Luis A Guzman
Each year about 700 000 people experience a new (500 000) or recurrent (200 000) stroke, and the great majority are ischemic events (88%). 1 Unlike acute coronary syndromes which are associated with in situ arterial occlusions, embolism is the most common mechanism related to ischemic strokes. Yet, contemporary studies have shown that thrombosis, inflammation, intraplaque hemorrhage, fibrous cap rupture, and large lipid necrotic core are common features of the atherothrombotic processes affecting both carotid and coronary arteries. 2 The clinical impact of each of these plaque characteristics was already suggested a few decades ago, 3 but the lack of epidemiologic studies and sensitive diagnostic tools has limited our therapeutic options to essentially secondary prevention and intervention of severe obstructive disease. This chapter will discuss emerging scientific evidence suggesting an important role of specific plaque features in the risk of ischemic cerebrovascular events. A detailed description of pathological characteristics, imaging modalities, and treatment indications of carotid artery disease are discussed in specific chapters of this book, and are beyond the scope of this chapter. Our intention is to describe recent advances in carotid plaque imaging in the context of specific plaque features and how they may potentially impact on future preventive and therapeutic approaches.