Role of carotid plaque analysis in therapeutic decision-making for carotid disease.

Carotid atherosclerosis is an important yet declining etiology of embolic stroke and cerebrovascular or retinal ischemic events with an embolic source. The severity of stenosis is the most important anatomic factor for deciding whether to use optimized medical therapy alone or interventional therapy. Recently, specific features of the atherosclerotic plaque have attracted increasing attention; for example, total plaque area, juxtaluminal black area, intraplaque hemorrhage, and mainly echolucent plaques are associated with high risk of late stroke, and these features now influence the therapeutic choices. This review describes the current state of carotid plaque analysis using different image modalities and its effect on current guidelines and clinical practice.