Roadmap consensus on carotid artery plaque imaging and impact on therapy strategies and guidelines: An international, multispecialty, expert review and position statement

Authors

L. Saba, Università degli Studi di Cagliari
W. Brinjikji, Mayo Clinic
J. D. Spence, Robarts Research InstituteFollow
M. Wintermark, Stanford University
M. Castillo, The University of North Carolina at Chapel Hill
G. J.D. Borst, University Medical Center Utrecht
Q. Yang, Xuanwu Hospital, Capital Medical University
C. Yuan, University of Washington
A. Buckler, Elucid Bioimaging Inc.
M. Edjlali, Université Paris Cité
T. Saam, Klinikum der Universität München
D. Saloner, University of California, San Francisco
B. K. Lal, University of Maryland School of Medicine
D. Capodanno, Università degli Studi di Catania
J. Sun, University of Washington
N. Balu, University of Washington
R. Naylor, Glenfield Hospital
A. V.D. Lugt, Erasmus MC
B. A. Wasserman, The Johns Hopkins Hospital
M. E. Kooi, CARIM School for Cardiovascular Disease
J. Wardlaw, Edinburgh Medical School
J. Gillard, Christ's College
G. Lanzino, Mayo Clinic
U. Hedin, Karolinska Institutet
D. Mikulis, University Health Network University of Toronto
A. Gupta, Weill Cornell Medicine
J. K. DeMarco, Uniformed Services University of the Health Sciences
C. Hess, University of California, San Francisco
J. V. Goethem, Universiteit Antwerpen

Document Type

Article

Publication Date

9-1-2021

Journal

American Journal of Neuroradiology

Volume

42

Issue

9

First Page

1566

Last Page

1575

URL with Digital Object Identifier

10.3174/ajnr.A7223

Abstract

Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.