title: Identifying the high-risk carotid plaque.
abstract: With the benefit of hindsight, most symptomatic (67%) and most asymptomatic patients (88%) who were treated medically in the randomized trials were never destined to suffer a stroke. As a consequence of a growing awareness that only a relative minority of patients actually benefit from surgery or stenting, there has been much debate about how contemporary imaging and serum biomarkers might be used to identify the patient with the "high-risk for stroke" plaque in whom to target surgery or stenting in the future. This is particularly important for patients with asymptomatic carotid disease in whom 95% of carotid surgical procedures are ultimately unnecessary. Even if the procedural risk could be reduced to zero, 93% of all interventions would still prove to be unnecessary. This paper reviews the rationale underlying the need to identify "high-risk for stroke" patients in whom to target invasive therapies. It reviews the pathophysiology of the unstable carotid plaque and how such a lesion might be identified using contemporary imaging modalities and serum biomarkers.
authors.affiliation: Vascular Surgery Group Division of Cardiovascular Sciences Leicester Royal Infirmary, Leicester, UK - ross.naylor@uhl-tr.nhs.uk.
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D015415:Biomarkers / Q000097:blood; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D003952:Diagnostic Imaging / Q000379:methods; D006801:Humans; D018810:Magnetic Resonance Angiography; D061330:Multidetector Computed Tomography; D064847:Multimodal Imaging; D018579:Patient Selection; D058226:Plaque, Atherosclerotic; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012422:Rupture, Spontaneous; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial; D018084:Ultrasonography, Interventional
chemical_list: D015415:Biomarkers