Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications

Luca Saba, Tobias Saam, H. Rolf Jäger, Chun Yuan, Thomas S. Hatsukami, David Saloner, Bruce A Wasserman, Leo H. Bonati, Max Wintermark

Research output: Contribution to journalReview article

Abstract

Stroke represents a massive public health problem. Carotid atherosclerosis plays a fundamental part in the occurence of ischaemic stroke. European and US guidelines for prevention of stroke in patients with carotid plaques are based on quantification of the percentage reduction in luminal diameter due to the atherosclerotic process to select the best therapeutic approach. However, better strategies for prevention of stroke are needed because some subtypes of carotid plaques (eg, vulnerable plaques) can predict the occurrence of stroke independent of the degree of stenosis. Advances in imaging techniques have enabled routine characterisation and detection of the features of carotid plaque vulnerability. Intraplaque haemorrhage is accepted by neurologists and radiologists as one of the features of vulnerable plaques, but other characteristics—eg, plaque volume, neovascularisation, and inflammation—are promising as biomarkers of carotid plaque vulnerability. These biomarkers could change current management strategies based merely on the degree of stenosis.

Original languageEnglish (US)
Pages (from-to)559-572
Number of pages14
JournalThe Lancet Neurology
Volume18
Issue number6
DOIs
StatePublished - Jun 1 2019

ASJC Scopus subject areas

  • Clinical Neurology

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    Saba, L., Saam, T., Jäger, H. R., Yuan, C., Hatsukami, T. S., Saloner, D., Wasserman, B. A., Bonati, L. H., & Wintermark, M. (2019). Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. The Lancet Neurology, 18(6), 559-572. https://doi.org/10.1016/S1474-4422(19)30035-3