High-Risk Carotid Plaque Features May Be More Accurate Predictors of Ipsilateral Ischemic Stroke Risk Than the Degree of Carotid Artery Stenosis.

Document Type

Article

Publication Date

2025

Publication Title

International angiology

Abstract

INTRODUCTION: The optimal management of patients with asymptomatic carotid stenosis (AsxCS) is enduringly controversial. The current stratification of AsxCS patients based on the degree of stenosis alone does not always reflect ipsilateral ischemic stroke risk. We hypothesized that the presence of ≥1 "high-risk" carotid plaque feature may more accurately identify AsxCS patients at high risk for a future ipsilateral ischemic cerebrovascular event.

EVIDENCE ACQUISITION: We reviewed the literature for evidence supporting an association between high-risk carotid plaque features with ipsilateral ischemic stroke risk.

EVIDENCE SYNTHESIS: Certain carotid plaque features, such as intraplaque hemorrhage, lipid-rich necrotic core, thinning/rupture of the fibrous cap, ulceration, or neovascularization, may more accurately stratify patients at low vs. high future stroke risk. The presence of ≥1 "high-risk" carotid plaque characteristics can inform decisions on the conservative vs. invasive management of AsxCS patients and target carotid revascularization procedures to those AsxCS patient subgroups at high stroke risk who are more likely to benefit from them.

CONCLUSIONS: The present article presents the rationale supporting stratification of AsxCS patients not based on the degree of stenosis, but on the presence of one or more specific high-risk plaque features that increase the risk of a future ipsilateral ischemic cerebrovascular event.

Volume

44

Issue

3

First Page

224

Last Page

234

Comments

Frederik Meijer Heart & Vascular Institute

DOI

10.23736/s0392-9590.25.05431-8

ISSN

1827-1839

PubMed ID

40856785

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