International Stroke Conference
February 6–8, 2019
Richard Jackson, MD
I’m writing to you from ISC reporting on an extremely well-planned lecture series on symptomatic carotid artery identification by imaging. I’ve always thought this topic extremely vague as the imaging technology progressed, the medical treatment progressed, but the evaluation and treatment remained surgical with guidelines from the 1990s and most of the research spread across multiple sub-specialties. This same sentiment was echoed today in each mini-series lecture. There’s no easy way to summarize each mini lecture except to keep it in its original format and hit the relevant highlights, which are numerous to say the least.
First Lecture: “Ultrasound Imaging of Carotid Wall and Plaque” by J David Spence
His focus is clearly the identification of vulnerable plaques by ultrasound, and he was a proponent of upcoming volumetric plaque morphology assessment. He quotes the prevalence of asymptomatic carotid stenosis in the >60 year old population at 10% and identifies vulnerable plaques using TCD with emboli detection and plaque characteristics as echo-lucency, hemorrhage, and plaque ulcerations. Of interest was a paper he showed in which TMAO and lecithins produced by intestinal flora worsened carotid stenosis. As GFR decreased, including with age, the metabolites increased, possibly explaining the age relationship to carotid stenosis. Also of interest were the timelines in which carotid stenosis responded to medication. He presented his own carotid plaque and showed a transition from hypoechoic to hyperechoic in 3 months with atorvastatin, and then presented a paper in which ezetimibe doubled the effectiveness of statin therapy.