Published Online
on October 20, 2005

A more recent version of this article appeared on November 1, 2005

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Submitted on May 25, 2005
Accepted on June 21, 2005

Low-Grade Carotid Stenosis. Looking Beyond the Lumen With MRI

Bruce A. Wasserman MD^*; Robert J. Wityk MD; Hugh H. Trout III MD; and Renu Virmani MD

From the Russell H. Morgan Department of Radiology and Radiological Sciences (B.A.W.) and the Department of Neurology (R.J.W.), The Johns Hopkins Hospital, Baltimore, Md; the Department of Surgery (H.H.T.), Suburban Hospital, Bethesda, Md; and CVPath (R.V.), International Registry of Pathology, Gaithersburg, Md.

^* To whom correspondence should be addressed. E-mail: bwasser{at}jhmi.edu.

Background and Purpose--The management of carotid atherosclerosis is well-established for symptomatic stenosis above 69%, but the optimal approach for managing lower degrees of narrowing remains uncertain. Because the risk of stroke increases with higher grades of stenosis, we are inclined to consider low-grade disease to be low risk. This approach, however, does not take into account other factors such as plaque size or composition. Plaque may progress to a substantial size before it demonstrates significant stenosis by angiography. We know that low-grade disease can result in cerebrovascular ischemic events, but predicting vulnerable lesions has not been possible by relying on stenosis alone.

Summary of Review--An understanding of the clinical behavior of plaque causing little to no narrowing is now possible with the advent of high-resolution black blood MRI, a modality that does not rely on luminal narrowing for detection.

Conclusion--We present the current understanding of the clinical implications of low-grade carotid stenosis with an example of the MRI assessment of high-risk carotid plaque causing minimal narrowing that highlights the importance of looking beyond the lumen.

Key words: atherosclerosis • carotid arteries • carotid stenosis • MRI • symptomatic carotid stenosis

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