Baradaran H, et al. - Whether a decision-making rule depending on the ultrasound imaging evaluation of plaque echolucency in patients with asymptomatic carotid stenosis represents a cost effective strategy, was investigated. Researchers tested 5 stroke prevention strategies, including medical therapy only, revascularization if both plaque echolucency and stenosis progression to > 90% are present, revascularization only if plaque echolucency is present, revascularization only if stenosis progression > 90% is present, or either plaque echolucency or stenosis progression is present, in terms of lifetime quality-adjusted life years and costs, using a decision-analytic model. An incremental cost-effectiveness ratio of $110 000/quality-adjusted life years was reported in the either plaque echolucency or progression-based revascularization group vs the plaque echolucency-based strategy, which yielded an incremental cost-effectiveness ratio of $29 000/quality-adjusted life years vs the joint echolucency and progression-based strategy. Based on the findings, experts viewed plaque echolucency on ultrasound as a tool that can be cost-effective to detect candidates most likely to benefit from carotid endarterectomy among asymptomatic carotid artery stenosis cases.