Carotid Atherosclerotic Disease: Pathologic Basis for Treatment PDF

Preface

This book grew from a discussion between the editors over the importance of looking beyond simple angiographic stenosis in the carotid vascular tree. We resolved to follow a pathway similar to what had been done in relation to the coronary vascular tree. In the coronary vascular tree, it is now generally accepted that sudden plaque complication with rupture and/or thrombosis of a "vulnerable" lesion causes most acute coronary events. This also appears to be true in the setting of cerebrovascular events. We explored the possibility that the combination of overall plaque burden and systemic triggers, such as inflammation, correlated with the risk of developing acute clinical syndromes, whether coronary or cerebrovascular. These findings initiated a paradigm shift in our approach to the patient affected by atherosclerotic disease.

Imaging of sub-clinical atherosclerosis is used for the detection and quantification of the atherosclerotic plaque burden. However, in the future the identification of a plaque burden without the requisite knowledge of the disease "activity" will not be sufficient to complete a comprehensive risk analysis, as not all plaques will result in a clinical event.

In Carotid Atherosclerotic Disease: Pathologic Basis for Treatment, leading authors in the field of coronary and carotid events have reviewed the natural history of carotid atherosclerotic plaque and outlined the various pathologic characteristics of the asymptomatic and symptomatic carotid plaque. Our intention is to give a pathology-based rationale for the assessment, risk stratification and decision-making involved in creating a therapeutic strategy for patients affected by carotid disease.

Given its importance, a number of chapters have been dedicated to the impact of carotid plaque imaging from high-resolution MRI to new Doppler imaging modalities and vasa vasorum detection in correctly assessing plaque risk stratification. The new concept of a stent tailored to an individual plaque morphology and a cerebral protection device chosen to match particular plaque features has been analysed in detail. Finally, future advancements in gene therapy and carotid arterial wall repair have been reviewed by those with a keen knowledge of the subject.

We hope that this work will provide the reader with the basic skills necessary to make the move from the old concept of when to treat, based on simple luminal narrowing, to the new concept of who should be treated, based on plaque and patient characteristics. This book is directed at students, physicians in training, cardiologists, vascular surgeons, and radiologists performing carotid interventions, providing a guide to appropriate carotid atherosclerotic treatment.