This paper shows that carotid stenosis is not just a problem of how narrow the artery looks: inflammation repeatedly emerges as the hidden biology that helps explain which plaques become dangerous, embolize, and lead to recurrent stroke. The full review is worth reading because it maps where PET imaging, blood biomarkers, and anti-inflammatory strategies may move carotid care beyond stenosis grading alone toward a more precise, risk-based treatment model.
Abstract: The aim of this review is to synthesize current research regarding the role of inflammation in CAS, evaluating the diagnostic utility of molecular imaging, the prognostic value of systemic inflammatory biomarkers, and the impact of anti-inflammatory interventions on plaque stability and clinical outcomes. The review utilises 496 original studies with 155393 total participants (topic deduplicated ΣN). The evidence map indicates that inflammation is a central feature of carotid stenosis biology and often tracks clinical risk more closely than luminal narrowing alone. A prominent signal was that carotid plaque inflammation measured by fluorodeoxyglucose positron emission tomography showed stronger short-term recurrence discrimination than the Symptomatic Carotid Atheroma Inflammation Lumen-stenosis score, with area under the curve values of 0.92 versus 0.79 in symptomatic disease, while recurrent stroke risk was also associated with higher inflammatory activity with reported hazard ratios of 2.19 and 4.57 in key cohorts. Across the mapped literature, convergent findings from histology, molecular imaging, and circulating biomarkers support a role for macrophage-rich inflammation, neovascularization, and cytokine signaling in plaque destabilization, microembolization, and recurrent ischemic events. The review also highlights practical clinical implications: combining stenosis severity with biological measures of inflammation may improve selection for urgent revascularization, and readily available systemic indices may help identify patients at higher risk of severe disease, restenosis, or procedural complications. At the same time, heterogeneity in methods and the predominance of observational evidence mean these signals should be interpreted as strong scoping patterns rather than definitive treatment rules. Future research should prioritize standardized prospective studies and randomized trials that test whether inflammation-guided imaging and targeted anti-inflammatory treatment can improve outcomes beyond conventional stenosis-based management.
Final search date and database lock: 2026-04-17 10:46:21 CEST
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Total Abstracts/Papers: 806
Downloaded Abstracts/Papers: 806
Included original and non-original Abstracts/Papers (all): 546
Included original Abstracts/Papers (Vote counting by direction of effect): 496
Reference Index (links used in paper): 133
Total participants (topic deduplicated ΣN): 155393
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