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Ischemic stroke occurs as a result of thromboembolism from ruptured carotid atheromatous plaques.1,2⇓ Histologic data from coronary atherosclerosis has suggested that plaque rupture may be predictable by thinness of fibrous caps that overlie large necrotic lipid cores and by the presence of large numbers of active macrophages.3 Therefore, identification of such “vulnerable” plaques has the potential to offer early aggressive pharmacotherapy, refine patient selection for surgery, and identify asymptomatic subjects thought to be at high risk of atherosclerosis based on risk factor assessment. High-resolution MRI of the carotid bifurcation has demonstrated that the fibrous cap and lipid core components can be identified using a multisequence algorithm4 and that such a technique may form the basis for automated classification of the diseased vessel.5 However, these techniques only provide structural and morphologic plaque characteristics. Invasive studies using …
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