Update on diagnostic approach of carotid disease: From stenosis to atherosclerotic plaque morphology

Stenosis of the carotid artery is a well-established risk factor for generating ischemic cerebral vascular event; it contributes in 10–20% of cerebral vascular events or transient ischemic attacks. Many clinical trials in the last 20 years have taken into account the percentage of stenosis as a parameter to stage the degree of risk of the patient. With the advances that have been made in imaging techniques such as ultrasound, CT Angiography and Carotid MR for vascular assessment, it is now possible to stage patients, not only based on the percentage of stenosis, but also for vulnerability or instability to be able to undergo a rupture of the plaque and that produces a cerebral vascular event of ischemic type. These imaging techniques are ushering in a change in the way of evaluating the carotid plaque that allows risk staging based on the characteristics of the image such as Intraplaque Hemorrhage (IPH), plaque ulceration, thickness of the fibrous layer, neovascularization of the plaque and the presence of Lipid Rich Necrotic Center in Lipids (LRNC). It is important for health professionals who are in contact with patients with this disease to be aware of these new imaging techniques, which are being applied to the diagnostic approach of carotid disease.