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Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement.
- Source :
- Journal of Stroke & Cerebrovascular Diseases; Nov2021, Vol. 30 Issue 11, p106182-106182, 1p
- Publication Year :
- 2021
-
Abstract
- <bold>Objectives: </bold>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.<bold>Materials and Methods: </bold>A literature review was performed with a focus on data from recent studies.<bold>Results: </bold>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 < 75 years and microembolic signals on transcranial Doppler. There is growing evidence that 80-99% ACS indicate a higher stroke risk than 50-79% stenoses.<bold>Conclusions: </bold>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. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10523057
- Volume :
- 30
- Issue :
- 11
- Database :
- Supplemental Index
- Journal :
- Journal of Stroke & Cerebrovascular Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 153394053
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2021.106182