A New Tracer for Imaging Atherosclerosis.

Abstract

Carotid artery disease accounts for ≈20% of strokes.1,2 Although the role of revascularization in reducing the incidence of stroke in symptomatic carotid stenosis is well established,1 the optimal treatment for asymptomatic disease remains controversial.2,3 In Asymptomatic Carotid Atherosclerosis Study (ACAS, published in 1995)4 and Asymptomatic Carotid Surgery Trial 1 (ACST-1, published in 2004),5 which enrolled patients with ≥60% carotid stenosis carotid endarterectomy (CEA) was found to be superior to medical therapy. Subsequent studies demonstrated that carotid stenting, the alternative revascularization procedure, is not inferior to CEA in these patients.6,7 However, recent advances in medical therapy have led to considerable reduction in stroke risk, such that the contemporary annual rate of ipsilateral stroke in medically managed patients with asymptomatic carotid stenosis (≤1%) is similar to the risks observed with revascularization in aforementioned trials.2 Accordingly, American Heart Association guidelines suggest that revascularization may be considered in a highly selected group of patients with asymptomatic carotid stenosis, acknowledging that the effectiveness of this approach compared to medical therapy is not well established.8 How to identify this high-risk group of patients remains more akin to an art than evidence-based medicine. Interestingly, in contrast to Canada and most of Europe, a great majority of carotid revascularization procedures in the United States are performed on asymptomatic patients,2 highlighting the magnitude of the problem and costs associated with potentially unnecessary procedures. See Article by Voo et al Focal thrombosis triggered by plaque rupture, superficial erosion, or protruding calcified nodule in the setting of predisposing systemic factors can be asymptomatic or lead to myocardial infarction and stroke. Plaque rupture is the main cause of such thrombotic complications in both coronary and carotid artery disease. The nidus for rupture, a thin-cap, highly inflammatory fibroatheroma …