La placca carotidea instabile nell’indicazione alla chirurgia

The unstable carotid plaque for indication and timing of surgical or endovascular correction Carotid Endarterectomy surgical procedure (CEA) has demonstrated through randomized trials its efficacy and superiority over best medical treatment in the prevention of stroke, in haemodynamic carotid stenoses (>70%) in symptomatic patients, and also in asymptomatics, provided a surgical complication rate below 3%. Correct indication to CEA or carotid angioplasty and stenting (CAS) and timing are essential to prevent cerebral ischemia. Previous neurologic symptoms are best predictors of stroke, but unstable plaque is directly involved in the pathogenesis of embolic stroke, as compared to percentage of stenosis. Inflammatory biomarkers of an active atherosclerotic process and new functional diagnostic procedures, still under assessment, add to Echodoppler, Angio TC, RM means to better define morpho-functional characters of the carotid plaque at risk, whose treatment cannot be delayed.