Recommendations are the following if the degree of the stenosis and the precise location of the stenosis are well defined. Ultrasonic Doppler duplex methods describe the composition and the surface topography of carotid plaques. Texture is a function of pixle size and, in a given region of interest, reflects the variability of the grey scale values. Magnetic resonance imaging with or without angiography may play a role in the future. In vitro studies show that MR can demonstrate plaque components such as fibrosis, calcification, hemorrhage and necrotic core, but current technical limitations related to resolution and motion artifacts prevent this from being implemented in vivo.
Pathological studies require en bloc surgery.
Component areas should be calculated from their length and width, and ulcerations measured from their width. The risk of cerebrovascular ischemia is clearly related to the degree of stenosis. Texture is still under investigation as a prognostic factor.