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Titel:

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

Dokumenttyp:
Journal Article; Review
Autor(en):
Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Antignani, Pier Luigi; Baradaran, Hediyeh; Bokkers, Reinoud P H; Cambria, Richard P; Dardik, Alan; Davies, Alun H; Eckstein, Hans-Henning; Faggioli, Gianluca; E Fernandes, Jose Fernandes; Fraedrich, Gustav; Geroulakos, George; Gloviczki, Peter; Golledge, Jonathan; Gupta, Ajay; Jezovnik, Mateja K; Kakkos, Stavros K; Katsiki, Niki; Knoflach, Michael; Kooi, M Eline; Lanza, Gaetano; Liapis, Christos D; Loftus, Ian M; Mansilha, Armando; Millon, Antoine; N...     »
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.
Zeitschriftentitel:
J Stroke Cerebrovasc Dis
Jahr:
2022
Band / Volume:
31
Heft / Issue:
1
Volltext / DOI:
doi:10.1016/j.jstrokecerebrovasdis.2021.106182
PubMed:
http://view.ncbi.nlm.nih.gov/pubmed/34735900
Print-ISSN:
1052-3057
TUM Einrichtung:
Fachgebiet Gefäßchirurgie (Prof. Eckstein)
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