Τίτλος:
Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is
Still Out. An International, Multispecialty, Expert Review and Position
Statement
Περίληψη:
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.
Συγγραφείς:
Paraskevas, Kosmas I.
Mikhailidis, Dimitri P.
Antignani, Pier
Luigi
Baradaran, Hediyeh
Bokkers, Reinoud P. H.
Cambria,
Richard P.
Dardik, Alan
Davies, Alun H.
Eckstein,
Hans-Henning
Faggioli, Gianluca
Fernandes e Fernande, Jose and
Fraedrich, Gustav
Geroulakos, George
Gloviczki, Peter and
Golledge, Jonathan
Jezovnik, Mateja K.
Kakkos, Stavros K. and
Katsiki, Niki
Knoflach, Michael
Kooi, M. Eline
Lanza,
Gaetano
Liapis, Christos D.
Loftus, Ian M.
Mansilha, Armando
and Millon, Antoine
Nicolaides, Andrew N.
Pini, Rodolfo and
Poredos, Pavel
Ricco, Jean-Baptiste
Riles, Thomas S. and
Ringleb, Peter Arthur
Rundek, Tatjana
Saba, Luca and
Schlachetzki, Felix
Silvestrini, Mauro
Spinelli, Francesco and
Stilo, Francesco
Sultan, Sherif
Suri, Jasjit S.
Zeebregts,
Clark J.
Chaturvedi, Seemant
