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  3. 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

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
  • Fernande, JFE
  • Fraedrich, G
  • Geroulakos, G
  • Gloviczki, P
  • Golledge, J
  • 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

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.

Copyright © 2021 Elsevier Inc. All rights reserved.

Dados da publicação

ISSN/ISSNe:
1052-3057, 1532-8511

JOURNAL OF STROKE & CEREBROVASCULAR DISEASES  W.B. Saunders Ltd

Tipo:
Review
Páginas:
106182-106182
Link para outro recurso:
www.scopus.com

Citações Recebidas na Web of Science: 15

Citações Recebidas na Scopus: 15

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Keywords

  • Asymptomatic carotid stenosis; Best medical treatment; Stroke; Carotid endarterectomy; Carotid plaque

Campos de estudo

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The role of infrared thermography in predicting diabetic foot outcomes

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Estudo Clínico Académico (diabetic foot) . 2021

Endovascular solutions for type IA endoleak after endovascular aneurysm repair

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Estudo Clínico Académico . 2021

Intermittent Claudication: Importance of Supervised Exercise Programme

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