Detection of Vulnerable Plaque in Patients with Cryptogenic Stroke

Abstract

In up to 40% of ischemic stroke cases the etiology remains unknown. A substantial proportion of these patients has non- or only mildly stenosing carotid artery plaques not fulfilling common criteria for large artery stroke, but beeing suspicious for arterio-arteriell embolism. Several imaging techniques allow the non-invasive analysis of plaque features. Nevertheless, carotid MRI might be best suited to assess the key features of vulnerable plaques. This review article discusses potential causes of cryptogenic stroke, the role of plaque imaging in non-stenosing plaques and the association of vulnerable plaques and specific plaque features with stroke risk and stroke recurrence.

Keywords: Carotid MR angiography; Carotid artery plaque; Cryptogenic stroke; Echogenicity; Fibrous cap rupture; Intraplaque hemorrhage; Lipid-rich necrotic core; Plaque inflammation.