Nonstenotic symptomatic internal carotid artery plaques: Epidemiology, pathophysiology, and treatment

Objective

Traditional views on carotid artery atherosclerosis have largely focused on the degree of stenosis as a predictor for embolic stroke. However, recent evidence highlights the significance of nonstenotic, vulnerable plaques in stroke pathophysiology. This article synthesizes current knowledge on the epidemiology, pathophysiology, and potential treatments of nonstenotic carotid plaques.

Methods

Google Scholar, PubMed, and Scopus were used to search for articles regarding “nonstenotic carotid plaques,” “embolic stroke of unknown source,” “cryptogenic stroke,” and “high-risk carotid imaging findings.” Here we conduct a narrative review of recent literature, focusing on studies published over the past decade, to understand the role of nonstenotic carotid plaques in ischemic strokes, particularly those classified as embolic strokes of unknown source. We present a representative case demonstrating these features.

Results

Nonstenotic plaques are increasingly recognized in patients with embolic strokes of unknown source, with vulnerable characteristics more prevalent on the symptomatic side. There is a higher risk of recurrent stroke in patients with these plaques, prompting reconsideration of therapeutic approaches, including the potential usefulness of carotid endarterectomy and stenting in certain cases.

Conclusions

The growing body of evidence on nonstenotic carotid plaques challenges existing paradigms in stroke management.