Low-grade carotid stenosis: looking beyond the lumen with MRI.

Abstract:

BACKGROUND AND PURPOSE:The management of carotid atherosclerosis is well-established for symptomatic stenosis above 69%, but the optimal approach for managing lower degrees of narrowing remains uncertain. Because the risk of stroke increases with higher grades of stenosis, we are inclined to consider low-grade disease to be low risk. This approach, however, does not take into account other factors such as plaque size or composition. Plaque may progress to a substantial size before it demonstrates significant stenosis by angiography. We know that low-grade disease can result in cerebrovascular ischemic events, but predicting vulnerable lesions has not been possible by relying on stenosis alone. SUMMARY OF REVIEW:An understanding of the clinical behavior of plaque causing little to no narrowing is now possible with the advent of high-resolution black blood MRI, a modality that does not rely on luminal narrowing for detection. CONCLUSIONS:We present the current understanding of the clinical implications of low-grade carotid stenosis with an example of the MRI assessment of high-risk carotid plaque causing minimal narrowing that highlights the importance of looking beyond the lumen.

journal_name

Stroke

journal_title

Stroke

authors

Wasserman BA,Wityk RJ,Trout HH 3rd,Virmani R

doi

10.1161/01.STR.0000185726.83152.00

subject

Has Abstract

pub_date

2005-11-01 00:00:00

pages

2504-13

issue

11

eissn

0039-2499

issn

1524-4628

pii

01.STR.0000185726.83152.00

journal_volume

36

pub_type

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