Low-grade carotid stenosis: Looking beyond the lumen with MRI

Bruce A. Wasserman, Robert J. Wityk, Hugh H. Trout, Renu Virmani

Research output: Contribution to journalReview articlepeer-review

149 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2504-2513
Number of pages10
Issue number11
StatePublished - Nov 2005


  • Atherosclerosis
  • Carotid arteries
  • Carotid stenosis
  • MRI
  • Symptomatic carotid stenosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing


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