About the book
Carotid artery disease is one of the most studied conditions in cardiovascular medicine. Stroke is among the leading causes of disability and disability-adjusted life years lost worldwide. Carotid plaque rupture, thrombosis, and embolization cause a substantial proportion of ischemic strokes. Preventing cerebrovascular incidents due to carotid artery disease is a challenging quest given the large population of patients affected by carotid atherosclerosis. While carotid endarterectomy and stenting are established treatments of symptomatic stenosis there is ambiguity and controversy about the treatment of asymptomatic carotid stenosis.
Risk factor modification, mainly antihypertensive drugs, decreased use of tobacco, antiplatelet agents and statins, decreased the risk of stroke in developed countries in recent decades. Decreasing incidence of stroke was observed also in patients with asymptomatic carotid stenosis making the results of some pivotal trials obsolete. The great debate shifts from the endarterectomy or stenting dispute to the selection of high-risk patients who would benefit most from invasive treatment. Stenosis severity, symptoms, age and comorbidities give only a few clues and are suboptimal in selecting patients for invasive treatment. Except for stroke prevention, other important factors like cognitive functions should be considered when assessing the effect of different treatments. While duplex ultrasound and computed tomography angiography remain the most utilized and available imaging modalities for carotid stenosis assessment, magnetic resonance imaging, intravascular ultrasound, optical coherence tomography, and near-infrared spectroscopy are used to characterize plaque composition and expected to detect vulnerable carotid plaques. Some of the high-risk features related to the carotid plaque (duplex ultrasound features, growth of the plaque, intraplaque hemorrhage and necrotic core, silent embolization) and patient (impaired cerebrovascular reserve, bilateral disease) have already been recognized and are reflected in the last European Society of Cardiology guidelines although the evidence is based mainly on single-center retrospective observational case-control studies. Carotid stenting evolved into the tailored procedure, the operator can choose from various stent designs, proximal or distal protection devices, intravascular imaging, and periprocedural monitoring to maximize the safety of the procedure. While the atherosclerotic disease is most common, non-atherosclerotic carotid artery disease in also encountered in clinical practice and can pose an even greater diagnostic and therapeutic challenge.
The book will intend to provide the reader with an overview of the imaging modalities including state-of-the-art intravascular imaging of the carotid artery, physiology of cerebral circulation, evidence-based treatments, technical aspects, complications and advances of carotid stenting and endarterectomy, risk stratification in asymptomatic carotid stenosis and diagnosis and treatment of non-atherosclerotic carotid disease.