Imaging of the vulnerable carotid plaque: role of imaging techniques and a research agenda

Objectives: Atherothrombosis in the carotid arteries is a main cause of ischemic stroke, and may depend on plaque propensity to complicate with rupture or erosion, in turn related to qualitative features amenable to in vivo imaging. This would provide an opportunity for risk stratification and – potentially – local treatment of more “vulnerable” plaques. We here review current information on this topic. Methods: We systematically reviewed the literature for concepts derived from pathophysiological, histopathological and clinical studies on imaging techniques attempting at identifying vulnerable carotid lesions. Results: Magnetic resonance imaging, computed tomography, ultrasound- and nuclear medicine-based techniques, alone or with multimodality approaches, all have a link to pathophysiology, and describe different – potentially complementary – aspects of lesions prone to complication. There is also, however, a true paucity of head-to-head comparisons of such techniques for practi...