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Advanced Carotid Vessel Wall Imaging and Future Directions

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Vessel Based Imaging Techniques

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Abstract

Carotid atherosclerosis is common in the general population and has been recognized as a major contributor to ischemic stroke. Luminal stenosis on angiography techniques is traditionally used to grade the severity of carotid disease in clinical decision-making, including multiple randomized clinical trials. However, this practice is challenged by histopathological studies that revealed a crucial role of carotid plaque characteristics in the pathogenesis of strokes secondary to carotid atherosclerosis. In the past two decades, the accessibility of carotid endarterectomy specimens has facilitated the development and validation of carotid vessel wall imaging, particularly magnetic resonance imaging (MRI) techniques, for identification of carotid plaque characteristics, including plaque burden, tissue composition, luminal surface condition, plaque inflammation, and neovasculature. Early work using traditional carotid MRI techniques to identify culprit lesions in symptomatic patients, to select patients at higher risk for stroke for carotid revascularization, to choose between carotid endarterectomy and carotid artery stenting, and to monitor patient response to medical treatment has shown the potential of vessel wall imaging in promoting precision medicine in patients with carotid disease. In the upcoming years, focus should be directed toward validation of new carotid vessel wall imaging techniques that may greatly improve the usability of imaging biomarkers of carotid plaque characteristics as well as multicenter, collaborative studies to collect high-level evidence for guiding clinical management of carotid disease.

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Authors and Affiliations

  1. Department of Radiology, University of Washington, Seattle, WA, USA

    Jie Sun

  2. Department of Surgery, University of Washington, Seattle, WA, USA

    Thomas S. Hatsukami

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  1. Jie Sun
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  2. Thomas S. Hatsukami
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Correspondence to Thomas S. Hatsukami .

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Editors and Affiliations

  1. University of Washington, Seattle, WA, USA

    Chun Yuan

  2. University of Washington, Seattle, WA, USA

    Thomas S. Hatsukami

  3. University of Washington, Seattle, WA, USA

    Mahmud Mossa-Basha

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Sun, J., Hatsukami, T.S. (2020). Advanced Carotid Vessel Wall Imaging and Future Directions. In: Yuan, C., Hatsukami, T., Mossa-Basha, M. (eds) Vessel Based Imaging Techniques . Springer, Cham. https://doi.org/10.1007/978-3-030-25249-6_6

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