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

• Type: Article in International Scientific Journal
• Date: 2022

Authors

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

Journal

The Journal is awaiting validation by the Administrative Services.

Title: INTERNATIONAL ANGIOLOGY

Vol. 41

Pages: 158-169

ISSN: 0392-9590

Publisher: EDIZIONI MINERVA MEDICA

Indexing

ISI Web of Knowledge - 0 Citations

Scopus

Other information

Authenticus ID: P-00W-BS7

DOI: 10.23736/s0392-9590.21.04825-2

Abstract (EN): 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)

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 12