Digital subtraction angiography for the analysis of supra-aortic vessels: What is its role nowadays?

For about 50 years, angiography represented the only imaging method for studying carotid arteries in order to detect the presence of pathological stenosis due to atherosclerotic plaque. Recently, thanks to the use of non-invasive methods, physicians are able to study and quantify the presence of carotid atherosclerosis in vivo. These procedures have enabled the introduction of new concepts: (1) the degree of carotid stenosis is approximate to the volume and extension of carotid plaque; and (2) a set of parameters, easily identifiable by computed tomography angiography, magnetic resonance angiogram and ultra-sound echo-color Doppler, are closely linked to the development of ischemic symptoms and can significantly increase the risk of stroke regardless of the degree of stenosis. In light of these findings, vulnerable plaques should be identified early, and the role of Digital Subtraction Angiography which is a purely technical luminal technique should be determined.