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(Stroke. 2006;37:759.)
© 2006 American Heart Association, Inc.

Editorials

Looking Beyond the Lumen to Predict Cerebrovascular Events

"The Road Less Travelled By"

Winfried A. Willinek, MD

From the University of Bonn, Department of Radiology, Bonn, Germany.

Correspondence to Winfried A. Willinek, University of Bonn, Department of Radiology, Sigmund-Freud-Str. 25, Bonn D-53105, Germany. E-mail winfried.willinek@ukb.uni-bonn.de

Key Words: atherosclerosis • carotid artery disease • magnetic resonance

An extract of the first 250 words of the full text is provided, because this article has no abstract.

See related article, pages 818–823.

I am not Robert Frost and this is not a literary review journal. I am a radiologist and it is my job to identify carotid artery disease. But of course, it is not unusual to dream as a physician that it would be possible, at some point, to identify the patient at risk and to predict future events in asymptomatic patients rather than just to detect carotid artery disease in symptomatic patients.

Carotid artery stenosis is a frequent finding in the general population with a prevalence of 75% in men and 62% in women over 64 years as determined by ultrasonography in the Cardiovascular Health Study.¹ Since the introduction of catheter angiography in the early 20th century,² luminal narrowing has become the standard parameter to report on the extent and severity of carotid artery stenosis. This is primarily related to several randomized clinical trials including the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) which relied on assessment of luminal narrowing. These trials demonstrated a significant reduction in stroke risk, after carotid endarterectomy compared with medical treatment alone, in patients with luminal stenosis of >69%.^3,4 However, the benefit of surgical treatment remains less clear in patients with lower grade carotid artery stenosis. Parameters other than luminal narrowing are needed to predict the risk of cerebrovascular events more reliably and to assess the potential benefit of carotid endarterectomy, particularly in the group of patients with moderate stenosis of 30% . . . [Full Text of this Article]

Related Article:

Association Between Carotid Plaque Characteristics and Subsequent Ischemic Cerebrovascular Events: A Prospective Assessment With MRI—Initial Results

Norihide Takaya, Chun Yuan, Baocheng Chu, Tobias Saam, Hunter Underhill, Jianming Cai, Nam Tran, Nayak L. Polissar, Carol Isaac, Marina S. Ferguson, Gwenn A. Garden, Steven C. Cramer, Kenneth R. Maravilla, Beverly Hashimoto, and Thomas S. Hatsukami
Stroke 2006 37: 818-823. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				A. R. Moody, R. Bitar, G. Leung, and R. Maggisano Looking Beyond the Lumen Does Make All the Difference Stroke, July 1, 2006; 37(7): 1648 - 1648. [Full Text] [PDF]