Management of Carotid Atherosclerosis Based on Vessel Wall Imaging

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  • YOSHIDA Kazumichi
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • YAMAMOTO Yu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • YAMADA Kiyofumi
    Department of Neurosurgery, Hyogo College of Medicine
  • OKAWA Masakazu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine
  • MIYAMOTO Susumu
    Department of Neurosurgery, Kyoto University Graduate School of Medicine

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  • Vessel wall imagingに基づく頚動脈硬化症の治療

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Abstract

<p>The risk of ischemic stroke due to carotid artery stenosis has long been assessed mainly based on luminal morphological characteristics such as stenosis and ulceration using angiography. Characteristics of the arterial wall itself have been revealed to play key roles in ischemic events with the recent development of vessel wall imaging (VWI) using modalities such as ultrasonography, computed tomography, and magnetic resonance imaging. In fact, some high-risk lesions in patients with nonstenotic carotid atherosclerosis could turn out to be ideal for surgical treatment.</p><p>Presently, stricter indications for carotid vascular surgery are required in accordance with the development of diagnostic VWI and improvements in multifaceted medical treatment, including intensive management of risk factors for atherosclerosis and lifestyle modifications. Treatment strategies for symptomatic low-grade stenosis and the development of diagnostic tools for asymptomatic vulnerable plaques have thus become new challenges.</p><p>This review article covers topics related to intraplaque hemorrhage, expansive remodeling, and radiation-induced atherosclerosis, with regard to carotid plaque assessment using VWI.</p>

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