Portal de investigação
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
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
- Tipo:
- Review
- Páginas:
- 158-169
- PubMed:
- 34913633
- Link para outro recurso:
- www.scopus.com
International Angiology Edizioni Minerva Medica S.p.A.
Citações Recebidas na Scopus: 2
Documentos
- Não há documentos
Filiações
Keywords
- Carotid stenosis; Stroke; Endarterectomy; carotid
Campos de Estudo
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