The behavior of acute symptomatic plaques

in the early phase is often underestimated, while an early p38 MAPK inhibitors clinical trials and accurate evaluation may be helpful to plan the most appropriate strategy to prevent further cerebrovascular events. Further efforts have to be performed to make a greater awareness in patients so that they arrive in specialized areas as soon as possible: this is a crucial node. The onset of neurological symptomatology must be considered as an emergency condition. Advances of arterial imaging, through conventional radiological imaging (CT and MR Angiography) [6] and [7] as well as with ultrasonography [8], converge to achieve more detailed information regarding the identification of these plaques. Summarizing, peculiar plaque characteristics such as severe degree of stenosis, low GSM and surface Atezolizumab ulceration are important predictors of plaque vulnerability and there are clear evidences that acute symptomatic plaques are always complicated, with low echogenicity and with relevant surface

alterations. However, acute symptomatic plaques in the very early phase have peculiar characteristics that are possible to detect with careful US investigations. Their incidence is often underestimated while an accurate evaluation may be helpful to plan the most appropriate strategy to prevent further cerebrovascular events. Acute symptomatic lesions have specific morphological aspects, and plaque rupture is a true adverse extremely unstable and common event in our experience in early phase. Data collected from recent studies indirectly confirm this condition: in the very acute stroke phase or in patients with transient ischemic attacks, the risk of recurrency is significantly higher and CEA significantly reduces the absolute (-)-p-Bromotetramisole Oxalate risk

of ipsilateral ischemic stroke [9] and [10]. As recently indicated by Wardlow et al. [11], “increasing delays to endarterectomy prevented fewer strokes”. In our experience, early ultrasonography performed with high resolution B-Mode imaging in real-time, quickly revealed in all these symptomatic plaques harmful characteristics, different from surface irregularities and chronic ulcerations, or low echogenicity or low GSM. Early admission to emergency-specific areas represents the early care in hospitalized centers and the 24 h availability of diagnostic facilities and operating rooms and vascular teams is a fundamental step to get a significant improvement of acute stroke patients prognosis. In conclusion, ultrasound vascular imaging is a key component of the evaluation of early ischemic carotid diseases. Acute symptomatic plaques are a well-defined entity that require early and accurate real-time evaluation, mandatory to thoroughly assess their unstable behavior, rare, but highly risk condition.