Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement
Kosmas I. Paraskevas,Dimitri P. Mikhailidis,Pier Luigi Antignani,Hediyeh Baradaran,Reinoud P H Bokkers,Richard P. Cambria,Alan Dardik,Alun H. Davies,Hans-Henning Eckstein,Gianluca Faggioli,José Fernandes e Fernandes,Gustav Fraedrich,George Geroulakos,Peter Gloviczki,Jonathan Golledge,Ajay Gupta,Mateja Kaja Jezovnik,Stavros K. Kakkos,Niki Katsiki,Michael Knoflach,M. Eline Kooi,Gaetano Lanza,Christos D. Liapis,Ian M. Loftus,Armando Mansilha,Antoine Millon,Andrew Nicolaides,Rodolfo Pini,Pavel Poredos,Jean-Baptiste Ricco,Thomas S. Riles,Peter A. Ringleb,Tatjana Rundek,Luca Saba,Felix Schlachetzki,Mauro Silvestrini,Francesco Spinelli,Francesco Stilo,Sherif Sultan,Jasjit S. Suri,Clark J. Zeebregts,Seemant Chaturvedi +41 more
TLDR
In this paper, a literature review was performed with a focus on data from recent studies and several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with carotid stenosis.Abstract:
Objectives The recommendations of international guidelines for the management of asymptomatic carotid stenosis (ACS) often vary considerably and extend from a conservative approach with risk factor modification and best medical treatment (BMT) alone, to a more aggressive approach with a carotid intervention plus BMT. The aim of the current multispecialty position statement is to reconcile the conflicting views on the topic. Materials and methods A literature review was performed with a focus on data from recent studies. Results Several clinical and imaging high-risk features have been identified that are associated with an increased long-term ipsilateral ischemic stroke risk in patients with ACS. Such high-risk clinical/imaging features include intraplaque hemorrhage, impaired cerebrovascular reserve, carotid plaque echolucency/ulceration/ neovascularization, a lipid-rich necrotic core, a thin or ruptured fibrous cap, silent brain infarction, a contralateral transient ischemic attack/stroke episode, male patients Conclusions Although aggressive risk factor control and BMT should be implemented in all ACS patients, several high-risk features that may increase the risk of a future cerebrovascular event are now documented. Consequently, some guidelines recommend a prophylactic carotid intervention in high-risk patients to prevent future cerebrovascular events. Until the results of the much-anticipated randomized controlled trials emerge, the jury is still out regarding the optimal management of ACS patients.read more
Citations
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Carotid endarterectomy or stenting or best medical treatment alone for moderate-to-severe asymptomatic carotid artery stenosis: 5-year results of a multicentre, randomised controlled trial
TL;DR: The European Carotid Surgery Trial (SPACE-2) as mentioned in this paper was designed as a three-arm trial including one group for BMT alone, and two groups for CAROTID endarterectomy (CEA) and carotid artery stenting (CAS).
Journal ArticleDOI
Extra-Cranial Carotid Artery Stenosis: An Objective Analysis of the Available Evidence
TL;DR: The “big” question is, does a carotid artery procedure add patient benefit in the modern era and, if so, for whom?
Journal ArticleDOI
Regarding Comparison of Recent Practice Guidelines for the Management of Patients with Asymptomatic Carotid Stenosis
Anne L. Abbott,Alejandro M. Brunser,O Uyagu,Hrvoje Budinčević,Konstantinos Spanos,Frank J. Veith +5 more
TL;DR: In this article , the authors pointed out that some recent guidelines are suitably more restrictive in endorsing "revascularization" procedures for asymptomatic carotid stenosis (ACS) patients by specifying, or at least considering, so-called high stroke risk features.
Journal ArticleDOI
Carotid ultrasound and coronary calcium for the prediction of incident cardiac disease in asymptomatic individuals: A further step towards precision medicine especially in women?
TL;DR: Gudmundsson et al. as discussed by the authors investigated the associations between carotid artery atherosclerosis and the presence and extent of CAC, as well as the ability of both markers (i.e., CAC and CARO) to predict future CHD events.
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