Neuroimaging and Interventional Radiology

Extra cranial internal carotid stenosis is a significant cause of stroke. However most patients with carotid stenosis remain a symptomatic even with high grade stenosis. Ultrasound studies of plaque morphology have been used to identify vulnerable plaque prone to rupture and embolization. Heterogeneous plaques with lucent areas are associated with a higher incidence of stroke and TIA. These lucencies correlate with thrombus and lipid on pathology. Sequential studies indicate that plaque growth is associated with stroke events. Further studies with black blood MRI document regression and solidification of plaque with staton medication. Ultrasound imaging of carotid plaque morphology provides a useful tool for identifying patients with a symptomatic carotid stenosis who may benefit most from interventional procedures to prevent stroke.