Symptomatic and asymptomatic carotid artery plaque

Abstract

Carotid atherosclerotic plaques represent both stable and unstable atheromatous lesions. Atherosclerotic plaques that are prone to rupture owing to their intrinsic composition such as a large lipid core, thin fibrous cap and intraplaque hemorrhage are associated with subsequent thromboembolic ischemic events. At least 15–20% of all ischemic strokes are attributable to carotid artery atherosclerosis. Characterization of plaques may enhance the understanding of natural history and ultimately the treatment of atherosclerotic disease. MRI of carotid plaque and embolic signals during transcranial Doppler have identified features beyond luminal stenosis that are predictive of future transient ischemic attacks and stroke. The value of specific therapies to prevent stroke in symptomatic and asymptomatic patients with severe carotid artery stenosis are the subject of current research and analysis of recently published clinical trials that are discussed in this article.

Keywords::

• carotid atherosclerosis
• carotid endarterectomy
• diagnostic studies
• medical therapy
• stenting
• stroke

Financial & competing interests disclosure

George Abela is a speaker for Merck, Abbott, CardioNet, GlaxoSmithKline and Takeda; he has received major grants from Merck and Novartis. Majid Mughal is a speaker for Gilead Sciences, United Therapeutics and Actelion. Arshad Majid is a speaker for Boeringher Ingelheim. J Kevin DeMarco is a speaker for ABC Medical Education and is is a subcontractor on William Kerwin, PhD (NIH grant no. R44-HL070576). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.