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Brain
Diagnosis
Pathology-Based Diagnoses
Stroke
Atherosclerosis and Carotid Stenosis
Extracranial Atherosclerosis
Extracranial Atherosclerosis
Hediyeh Baradaran, MD; Karen L. Salzman, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Abbreviations

              • Atherosclerotic vascular disease (ASVD)

            • Definitions

              • Degenerative process resulting from plasma lipid deposition in arterial walls

            IMAGING

            • General Features

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          DIAGNOSTIC CHECKLIST

                                          • Consider

                                            Selected References

                                            1. Baradaran H et al: Carotid vessel wall imaging on CTA. AJNR Am J Neuroradiol. 41(3):380-6, 2020
                                            2. Yuan J et al: Imaging carotid atherosclerosis plaque ulceration: comparison of advanced imaging modalities and recent developments. AJNR Am J Neuroradiol. 38(4):664-71, 2017
                                            3. Eisenmenger LB et al: Prediction of carotid intraplaque hemorrhage using adventitial calcification and plaque thickness on CTA. AJNR Am J Neuroradiol. 37(8):1496-503, 2016
                                            4. de Rotte AA et al: Plaque components in symptomatic moderately stenosed carotid arteries related to cerebral infarcts: The Plaque At RISK Study. Stroke. 46(2):568-71, 2015
                                            5. Gupta A et al: CT angiographic features of symptom-producing plaque in moderate-grade carotid artery stenosis. AJNR Am J Neuroradiol. 36(2):349-54, 2015
                                            6. Gupta A et al: Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Stroke. 46(1):91-7, 2015
                                            7. Howard DP et al: Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk. Stroke. 46(1):182-9, 2015
                                            8. McNally JS et al: Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke. 46(1):84-90, 2015
                                            9. Narumi S et al: Carotid plaque characterization using 3D t1-weighted MR imaging with histopathologic validation: a comparison with 2D Technique. AJNR Am J Neuroradiol. 36(4):751-6, 2015
                                            10. Skagen K et al: Carotid plaque inflammation assessed with 18 F-FDG PET/CT is higher in symptomatic compared with asymptomatic patients. Int J Stroke. 10(5):730-6, 2015
                                            11. Sun K et al: Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries. Eur J Radiol. 84(3):398-406, 2015
                                            12. Kaproth-Joslin KA et al: The essentials of extracranial carotid ultrasonographic imaging. Radiol Clin North Am. 52(6):1325-42, 2014
                                            13. Lv P et al: Detection of carotid artery stenosis: a comparison between 2 unenhanced MRAs and dual-source CTA. AJNR Am J Neuroradiol. 35(12):2360-5, 2014
                                            14. Michel JB et al: Pathology of human plaque vulnerability: mechanisms and consequences of intraplaque haemorrhages. Atherosclerosis. 234(2):311-9, 2014
                                            15. Gupta A et al: Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke. 44(11):3071-7, 2013
                                            16. Arora S et al: Optimal carotid artery coverage for carotid plaque CT-imaging in predicting ischemic stroke. J Neuroradiol. 37(2):98-103, 2010
                                            17. Babiarz LS et al: Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis. AJNR Am J Neuroradiol. 30(4):761-8, 2009
                                            18. Ota H et al: Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps. An in vivo 3T MRI study. Arterioscler Thromb Vasc Biol. 29(10):1696-701, 2009
                                            19. Saba L et al: CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results: potentialities and advantages of multidetector row CT angiography. AJNR Am J Neuroradiol. 28(6):1061-6, 2007
                                            20. Chen CJ et al: Multi-slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke. 35(1):83-5, 2004
                                            21. Nederkoorn PJ et al: Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke. 34(5):1324-32, 2003
                                            22. Binaghi S et al: Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis. Eur Neurol. 46(1):25-34, 2001
                                            23. Moll R et al: Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler. Eur J Radiol. 39(3):155-62, 2001
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Atherosclerotic vascular disease (ASVD)

                                                      • Definitions

                                                        • Degenerative process resulting from plasma lipid deposition in arterial walls

                                                      IMAGING

                                                      • General Features

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Angiographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          • Microscopic Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      Selected References

                                                                                      1. Baradaran H et al: Carotid vessel wall imaging on CTA. AJNR Am J Neuroradiol. 41(3):380-6, 2020
                                                                                      2. Yuan J et al: Imaging carotid atherosclerosis plaque ulceration: comparison of advanced imaging modalities and recent developments. AJNR Am J Neuroradiol. 38(4):664-71, 2017
                                                                                      3. Eisenmenger LB et al: Prediction of carotid intraplaque hemorrhage using adventitial calcification and plaque thickness on CTA. AJNR Am J Neuroradiol. 37(8):1496-503, 2016
                                                                                      4. de Rotte AA et al: Plaque components in symptomatic moderately stenosed carotid arteries related to cerebral infarcts: The Plaque At RISK Study. Stroke. 46(2):568-71, 2015
                                                                                      5. Gupta A et al: CT angiographic features of symptom-producing plaque in moderate-grade carotid artery stenosis. AJNR Am J Neuroradiol. 36(2):349-54, 2015
                                                                                      6. Gupta A et al: Plaque echolucency and stroke risk in asymptomatic carotid stenosis: a systematic review and meta-analysis. Stroke. 46(1):91-7, 2015
                                                                                      7. Howard DP et al: Symptomatic carotid atherosclerotic disease: correlations between plaque composition and ipsilateral stroke risk. Stroke. 46(1):182-9, 2015
                                                                                      8. McNally JS et al: Intraluminal thrombus, intraplaque hemorrhage, plaque thickness, and current smoking optimally predict carotid stroke. Stroke. 46(1):84-90, 2015
                                                                                      9. Narumi S et al: Carotid plaque characterization using 3D t1-weighted MR imaging with histopathologic validation: a comparison with 2D Technique. AJNR Am J Neuroradiol. 36(4):751-6, 2015
                                                                                      10. Skagen K et al: Carotid plaque inflammation assessed with 18 F-FDG PET/CT is higher in symptomatic compared with asymptomatic patients. Int J Stroke. 10(5):730-6, 2015
                                                                                      11. Sun K et al: Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries. Eur J Radiol. 84(3):398-406, 2015
                                                                                      12. Kaproth-Joslin KA et al: The essentials of extracranial carotid ultrasonographic imaging. Radiol Clin North Am. 52(6):1325-42, 2014
                                                                                      13. Lv P et al: Detection of carotid artery stenosis: a comparison between 2 unenhanced MRAs and dual-source CTA. AJNR Am J Neuroradiol. 35(12):2360-5, 2014
                                                                                      14. Michel JB et al: Pathology of human plaque vulnerability: mechanisms and consequences of intraplaque haemorrhages. Atherosclerosis. 234(2):311-9, 2014
                                                                                      15. Gupta A et al: Carotid plaque MRI and stroke risk: a systematic review and meta-analysis. Stroke. 44(11):3071-7, 2013
                                                                                      16. Arora S et al: Optimal carotid artery coverage for carotid plaque CT-imaging in predicting ischemic stroke. J Neuroradiol. 37(2):98-103, 2010
                                                                                      17. Babiarz LS et al: Contrast-enhanced MR angiography is not more accurate than unenhanced 2D time-of-flight MR angiography for determining > or = 70% internal carotid artery stenosis. AJNR Am J Neuroradiol. 30(4):761-8, 2009
                                                                                      18. Ota H et al: Hemorrhage and large lipid-rich necrotic cores are independently associated with thin or ruptured fibrous caps. An in vivo 3T MRI study. Arterioscler Thromb Vasc Biol. 29(10):1696-701, 2009
                                                                                      19. Saba L et al: CT and ultrasound in the study of ulcerated carotid plaque compared with surgical results: potentialities and advantages of multidetector row CT angiography. AJNR Am J Neuroradiol. 28(6):1061-6, 2007
                                                                                      20. Chen CJ et al: Multi-slice CT angiography in diagnosing total versus near occlusions of the internal carotid artery: comparison with catheter angiography. Stroke. 35(1):83-5, 2004
                                                                                      21. Nederkoorn PJ et al: Duplex ultrasound and magnetic resonance angiography compared with digital subtraction angiography in carotid artery stenosis: a systematic review. Stroke. 34(5):1324-32, 2003
                                                                                      22. Binaghi S et al: Three-dimensional computed tomography angiography and magnetic resonance angiography of carotid bifurcation stenosis. Eur Neurol. 46(1):25-34, 2001
                                                                                      23. Moll R et al: Value of the CT angiography in the diagnosis of common carotid artery bifurcation disease: CT angiography versus digital subtraction angiography and color flow Doppler. Eur J Radiol. 39(3):155-62, 2001