Stroke prevention: carotid intervention based on catheter angiography versus noninvasive vascular imaging.
Historically, imaging evaluation before carotid revascularization by endarterectomy or stenting has relied on targeting the cervical carotid using catheter angiography as the gold standard. This approach underestimates the anatomic and functional importance of the brain as the target organ by focusing the decision-making process on an isolated segment of the circulation. Since revascularization alternatives have been expanded to include the more proximal aortic and more distal intracranial circulations, it is essential to image the vascular tree from the heart to the brain. Equally important is accurate clinical correlation and functional imaging correlation, so that unnecessary surgery is avoided and there is no lost opportunity for stroke prevention.
Brook
Allan L
AL
Department of Neuroradiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467-2490, USA. abrook@montefiore.org
Mirsky
David M
DM
Bello
Jacqueline A
JA
D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy*; D002404:Catheterization; D016894:Endarterectomy, Carotid; D006801:Humans; D015641:Radiography, Interventional; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*