Carotid plaque type should play a role in indications for carotid intervention

Patient selection for carotid artery revascularization has been traditionally based on the degree of stenosis and neurological symptoms. Historically, adequate consideration has not been given to the morphology of the carotid plaque, even if we now know that some features of the carotid plaque may significantly influence clinical outcomes and so are central to patient selection. In this review we discuss the current clinical role of carotid plaque characterization as an indicator for carotid intervention. At the same time the rapid diffusion of carotid stenting as a less invasive alternative to carotid endarterectomy has increased the need for a continuous critical evaluation of indications and outcomes. This review also evaluates if characterization of the carotid plaque can be considered a reliable parameter among the indications for carotid stenting.