Atherosclerotic carotid artery disease is a well-defined risk factor for stroke, and other forms of cerebrovascular disease such as cognitive impairment. Research progress has advanced our understanding of the basic pathophysiology of atherosclerosis, and recent findings opened venues that could lead to the development of therapies and more individualized prophylactic treatment of cerebrovascular disease in general, and of carotid artery disease in particular. Emerging non-invasive imaging techniques show promising results to identify biological and molecular processes in vivo, offering potential benefits for identification of vulnerable atherosclerotic lesions and development of new therapies. In the present article we review current concepts in the pathophysiology of carotid artery atherosclerosis, specifically the role of select markers of endothelial dysfunction and extracellular matrix remodeling in atherosclerosis and carotid artery disease, as well as available non invasive diagnostic methods to assess pathologic events in carotid lesions and discuss the potential role of these processes as targets for the development of new therapies in cerebrovascular disease prevention.
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