Carotid imaging

Stroke is the second most common cause of death in developed countries and carotid atherosclerotic disease accounts for up to 25% of strokes. A high degree of stenosis, inflammation of the plaque, thin fibrous caps, intraplaque hemorrhage and lipid rich necrotic cores are strongly predictive of future embolic events in patients with carotid stenosis. Thus, the ability to detect these pathologies in patients with stenosis is essential to preventing future embolic events. Over the past decade, great advances have been made in carotid imaging as we cannot only effectively measure degree of stenosis of carotid arteries, but also measure prognostic variables such as degree of inflammation, macrophage infiltration, fibrous cap to lipid-rich core ratio and intraplaque hemorrhage with improved imaging techniques and technologies. The purpose of this review was to inform the surgical community on the advancements that have been made in carotid imaging specifically focusing on techniques that allow clinicians to distinguish between dangerous and innocuous plaques.