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Title:

Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement.

Document type:
Journal Article
Author(s):
Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Antignani, Pier L; Baradaran, Hediyeh; Bokkers, Reinoud Ph; Cambria, Richard P; Dardik, Alan; Davies, Alun H; Eckstein, Hans-Henning; Faggioli, Gianluca; Fernandes E Fernandes, José; 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; Nicola...     »
Abstract:
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 was to reconcile the conflicting views on the topic. A literature review was performed with a focus on data from recent studies. 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. 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.
Journal title abbreviation:
Int Angiol
Year:
2022
Journal volume:
41
Journal issue:
2
Pages contribution:
158-169
Fulltext / DOI:
doi:10.23736/S0392-9590.21.04825-2
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/34913633
Print-ISSN:
0392-9590
TUM Institution:
Professur für Gefäßchirurgie (Prof. Eckstein)
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