Identifying high-risk asymptomatic carotid stenosis

Chrysi Bogiatzi, Myra S. Cocker, Robert Beanlands, J. David Spence

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


Introduction: With more intensive medical therapy, the risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now below the risk of carotid endarterectomy or stenting (intervention); ∼ 90% of patients would be better with only medical therapy. It is important, therefore, to have methods to identify the ∼ 10% of patients who stand to benefit from intervention. Areas covered: We review the evidence that the risk of asymptomatic stenosis is now below the risk of intervention, and evidence for several approaches to identifying high-risk ACS: transcranial Doppler embolus detection, echolucency and neovascularity on ultrasound, ulceration on three-dimensional ultrasound, plaque composition on magnetic resonance imaging (MRI), plaque inflammation on positron emission tomography and assessment of cerebral blood flow reserve. Expert opinion: Carotid endarterectomy or stenting should be performed only in patients with ACS if they have microemboli on transcranial Doppler, three or more ulcers detected on three-dimensional ultrasound or other features of unstable plaque such as plaque echolucency on ultrasound, intraplaque hemorrhage detected on MRI, inflamed plaques detected on PET/CT or reduced cerebral blood flow reserve. Most patients with ACS (∼ 90%) would be better off with intensive medical therapy than with intervention.

Original languageEnglish (US)
Pages (from-to)139-151
Number of pages13
JournalExpert Opinion on Medical Diagnostics
Issue number2
StatePublished - Mar 2012


  • Asymptomatic carotid stenosis
  • High risk
  • MRI
  • PET/CT
  • Three-dimensional ultrasound
  • Transcranial Doppler microemboli
  • Ulceration
  • Vulnerable plaque

ASJC Scopus subject areas

  • Molecular Medicine
  • Biomedical Engineering
  • Biochemistry, medical


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