Carotid Atherosclerotic Disease
Pathologic Basis for Treatment
Edited by Giuseppe Sangiorgi, David R. Holmes, Kenneth Rosenfield, L. Nelson Hopkins, Luigi Spagnoli
CRC Press – 2008 – 396 pages
Carotid Atherosclerotic Disease: Pathologic Basis for Treatment reviews the natural history of carotid atherosclerotic plaque and outlines different pathologic characteristics of asymptomatic and symptomatic carotid plaque with the intent to give a pathology-based rationale for assessment, risk stratification and decision-making therapeutic strategy of patients affected by carotid disease. Another section further illustrates - in a evidence based medicine format - the impact of carotid plaque imaging from high-resolution MRI to new Doppler imaging modalities and vasa vasorum detection to correctly assess plaque risk stratification. The new concept of a tailored stent for different plaque morphologies and usage of dedicated cerebral protection devices in presence of particular plaque features will be pointed up. The concluding section sheds light on future advancement in gene therapy and carotid arterial wall repair. This volume offers the reader all the basis necessary to shift 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.
Section 1: Epidemiology. Incidence and Prevalence of Carotid Atherosclerosis. Section 2: Pathologic Basis of Carotid Atherosclerotic Disease. Carotid Atherogenesis: from Experimental Models to Human. Natural History of Carotid Atherosclerotic Plaque. Pathobiologic Determinants of Carotid Plaque Development. Anatomo-clinical Correlation Between Symptomatic Plaque and Ischemic Damage. Risk Factors and the Morphology of Atherosclerotic Carotid Plaque From Coronaries to Carotids: Shifting the Paradigm of Plaque Vulnerability. Section 3: Imaging of the Carotid Plaque. Imaging Modalities to Identify High-risk Subgroups. EcoDoppler: Diagnostic Tool or also an Impact on Indication and Treatment? Role of Angiography and IVUS 110. Optimal Utilization of Spiral-CT and MRI. Section 4: Carotid Atherosclerosis Treatment. Medical Treatment for Carotid Atherosclerosis Prevention. Two Similar Stories: From CABG to PCI and from CEA to CAS 13. Registry and Trials of CAS Vs. CEA. Should Interventional Strategy be Based on Diagnostic Imaging? Protection Devices: A Must or an Option? Acute Stroke Treatment. The Role of Surgery. Credentialing for Carotid Stenting. Section 5: Future Developments. New Diagnostic Tools to Identify Vulnerable Carotid Plaques & Targeting for Pharmacologic/gene Therapy in Carotid Atherosclerotic Disease