Ultrasonic imaging of the carotid arteries, from intima-media thickness to histological markers for plaque vulnerability: what do we know?

Carotid intima-media thickness has been evaluated as a predictor of cardiovascular disease and as a surrogate end point, but it cannot be equated with early atherosclerosis simply, because it reflects aging and hemodynamic load. Metaanalyses suggest that its added value as a risk factor is small, and that changes correlate poorly with clinical events. Carotid plaque is a stronger predictor of myocardial infarction and stroke. The protocols used in trials are rarely applied in routine practice. Prospective head-to-head comparisons are needed to demonstrate which imaging tools are most useful for preclinical diagnosis-because their results can influence treatment and outcomes-before these tests are advocated for individual patients