Clinical CT imaging of carotid arteries

A better understanding of the role of carotid plaque components in predicting ischemic stroke will be important in designing future treatment trials for carotid artery stenosis. A decade ago, studies demonstrated a clear advantage in certain populations of endarterectomy compared with medical therapy. However, these studies were conducted before the widespread use of medical treatments that have been demonstrated to reduce stroke risk in patients with vascular disease, such as clopidogrel; extended-release dipyridamole; and aspirin, statins, and more aggressive blood pressure control. With the development of both improved medical therapy and less invasive percutaneous stenting approaches over the last few years, some of the same questions must be addressed again. Should our hypotheses prove correct, these results will provide a relevant, standardized, and validated method of interpreting the carotid artery wall findings using a routine imaging technique that could be used in future trials to monitor the carotid wall composition, both to select patients for treatment and to determine whether drug treatments are effective in altering the size and composition of the atheroma.