Back to Search Start Over

Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

Authors :
Paraskevas, K.I.
Paraskevas, K.I.
Mikhailidis, D.P.
Antignani, P.L.
Baradaran, H.
Bokkers, R.P.H.
Cambria, R.P.
Dardik, A.
Davies, A.H.
Eckstein, H.H.
Faggioli, G.
Fernande, J.F.E.
Fraedrich, G.
Geroulakos, G.
Gloviczki, P.
Golledge, J.
Jezovnik, M.K.
Kakkos, S.K.
Katsiki, N.
Knoflach, M.
Kooi, M.E.
Lanza, G.
Liapis, C.D.
Loftus, I.M.
Mansilha, A.
Millon, A.
Nicolaides, A.N.
Pini, R.
Poredos, P.
Ricco, J.B.
Riles, T.S.
Ringleb, P.A.
Rundek, T.
Saba, L.
Schlachetzki, F.
Silvestrini, M.
Spinelli, F.
Stilo, F.
Sultan, S.
Suri, J.S.
Zeebregts, C.J.
Chaturvedi, S.
Paraskevas, K.I.
Paraskevas, K.I.
Mikhailidis, D.P.
Antignani, P.L.
Baradaran, H.
Bokkers, R.P.H.
Cambria, R.P.
Dardik, A.
Davies, A.H.
Eckstein, H.H.
Faggioli, G.
Fernande, J.F.E.
Fraedrich, G.
Geroulakos, G.
Gloviczki, P.
Golledge, J.
Jezovnik, M.K.
Kakkos, S.K.
Katsiki, N.
Knoflach, M.
Kooi, M.E.
Lanza, G.
Liapis, C.D.
Loftus, I.M.
Mansilha, A.
Millon, A.
Nicolaides, A.N.
Pini, R.
Poredos, P.
Ricco, J.B.
Riles, T.S.
Ringleb, P.A.
Rundek, T.
Saba, L.
Schlachetzki, F.
Silvestrini, M.
Spinelli, F.
Stilo, F.
Sultan, S.
Suri, J.S.
Zeebregts, C.J.
Chaturvedi, S.
Source :
Journal of Stroke & Cerebrovascular Diseases vol.31 (2022) date: 2022-01-01 nr.1 [ISSN 1052-3057]
Publication Year :
2022

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 < 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. 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. (c) 2021 Elsevier Inc. All rights reserved.

Details

Database :
OAIster
Journal :
Journal of Stroke & Cerebrovascular Diseases vol.31 (2022) date: 2022-01-01 nr.1 [ISSN 1052-3057]
Notes :
DOI: 10.1016/j.jstrokecerebrovasdis.2021.106182, English
Publication Type :
Electronic Resource
Accession number :
edsoai.on1336952934
Document Type :
Electronic Resource