Conclusions
A cornerstone of stroke prevention has been the identification of risk factors. While great strides have been made with the treatment of hypertension and hyperlipidemia, future reductions in stroke may require the identification of individual risk factors. In this paper we have reviewed current concepts of vulnerable plaque and demonstrated the ability of in vivo MRI to depict these vulnerable carotid plaque features. Multiple single-center studies have shown the ability of MRI-defined carotid plaque features to predict future events better than simple carotid artery stenosis measurements. Ongoing and proposed multicenter trials across North America and Europe will test the feasibility of vulnerable plaque imaging to accurately predict the risk of new thromboembolic symptoms. Future interventional and drug trials using vulnerable plaque imaging to guide individual patient selection and treatment are now being proposed.