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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

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Armando Amilcar Pires Mansilha Rodrigues De Almeida

    Autor

Participantes de fora da FMUP

  • Paraskevas, KI
  • Mikhailidis, DP
  • Antignani, PL
  • Baradaran, H
  • Bokkers, RPH
  • Cambria, RP
  • Dardik, A
  • Davies, AH
  • Eckstein, HH
  • Faggioli, G
  • Fernandes, JFE
  • Fraedrich, G
  • Geroulakos, G
  • Gloviczki, P
  • Golledge, J
  • Gupta, A
  • Jezovnik, MK
  • Kakkos, SK
  • Katsiki, N
  • Knoflach, M
  • Kooi, ME
  • Lanza, G
  • Liapis, CD
  • Loftus, IM
  • Millon, A
  • Nicolaides, AN
  • Pini, R
  • Poredos, P
  • Ricco, JB
  • Riles, TS
  • Ringleb, PA
  • Rundek, T
  • Saba, L
  • Schlachetzki, F
  • Silvestrini, M
  • Spinelli, F
  • Stilo, F
  • Sultan, S
  • Suri, JS
  • Zeebregts, CJ
  • Chaturvedi, S

Unidades de investigação

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. (Cite this article as: Paraskevas KI, Mikhailidis DP, Antignani PL, Baradaran H, Bokkers RP, Cambria RP, et al. Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement. Int Angiol 2022;41:158-69. DOI: 10.23736/S03929590.21.04825-2)

Dados da publicação

ISSN/ISSNe:
0392-9590, 1827-1839

International Angiology  Edizioni Minerva Medica S.p.A.

Tipo:
Review
Páginas:
158-169
Link para outro recurso:
www.scopus.com

Citações Recebidas na Scopus: 2

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Keywords

  • Carotid stenosis; Stroke; Endarterectomy; carotid

Campos de estudo

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