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(Stroke. 2005;36:2504.)
© 2005 American Heart Association, Inc.

Progress Reviews

Low-Grade Carotid Stenosis

Looking Beyond the Lumen With MRI

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.

Correspondence to Bruce A. Wasserman, MD, The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Hospital, Phipps B-100, 600 N Wolfe St, Baltimore, MD 21287. 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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