04 Aug 21. Featured Paper

Link to paper on American Journal of Neuroradiology

Authors

L. Saba, W. Brinjikji, J.D. Spence, M. Wintermark, M. Castillo, G.J.D. Borst, Q. Yang, C. Yuan, A. Buckler, M. Edjlali, T. Saam, D. Saloner, B.K. Lal, D. Capodanno, J. Sun, N. Balu, R. Naylor, A.v.d. Lugt, B.A. Wasserman, M.E. Kooi, J. Wardlaw, J. Gillard, G. Lanzino, U. Hedin, D. Mikulis, A. Gupta, J.K. DeMarco, C. Hess, J.V. Goethem, T. Hatsukami, P. Rothwell, M.M. Brown & A.R. Moody

Abstract

Current guidelines for primary & secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis & symptom status.

Recent publications have demonstrated that plaque morphology & composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease.

This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, & clinical decision-making in addition to the degree of stenosis.

To further this discussion, this roadmap consensus article defines the limits of luminal imaging & highlights the current evidence supporting the role of plaque imaging.

Furthermore, we identify gaps in current knowledge & suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.

Keywords

• Carotid atherosclerosis
• Plaque imaging
• Stroke