Carotid Imaging in 2023: Stenosis and Beyond

In the last two decades, significant advances have been made in the further understanding of carotid atherosclerosis and stroke risk. While currently practical stratification regarding a surgical intervention in patients with symptomatic carotid disease is made based on the degree of luminal narrowing, several plaque features have been identified as independent risk factors for the development of downstream ischaemic events. Several of these plaque features can be readily identified on routine CT- and MR-examinations, and will be discussed during this lecture. Consequently, a contemporary radiology report must go beyond a mere description of the presence and degree of luminal narrowing, and must also provide information on plaque morphology and other vessel wall characteristics. This comprehensive approach will enable the referring clinical to better stratify their patients regarding current and future risk, leading to better patient management and clinical outcomes