Plaque Assessment in the Management of Patients with Asymptomatic Carotid Stenosis

The continued occurrence of stroke despite advances in medical therapy for asymptomatic carotid stenosis (ACS) strongly indicates that individual response to medical therapy may vary widely. This article reviews the literature that identifies MR imaging and ultrasound plaque features which are seen in patients at increased risk of future cardiovascular events. Imaging can identify plaque phenotype that is the most amendable to intensive medical therapy. There is also good evidence that plaque imaging can measure the individual response to medical therapy and the lack of response identifies a high-risk group of ACS patients.

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The presence of carotid intraplaque hemorrhage and/or ulceration in patients with asymptomatic carotid stenosis may require close monitoring to identify progression despite intensive medical therapy that is better treated with surgical intervention.

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