Paraskevas, Kosmas I. and Mikhailidis, Dimitri P. and Antignani, Pier Luigi and Baradaran, Hediyeh and Bokkers, Reinoud P. H. and Cambria, Richard P. and Dardik, Alan and Davies, Alun H. and Eckstein, Hans-Henning and Faggioli, Gianluca and Fernandes e Fernande, Jose and Fraedrich, Gustav and Geroulakos, George and Gloviczki, Peter and Golledge, Jonathan and Jezovnik, Mateja K. and Kakkos, Stavros K. and Katsiki, Niki and Knoflach, Michael and Kooi, M. Eline and Lanza, Gaetano and Liapis, Christos D. and Loftus, Ian M. and Mansilha, Armando and Millon, Antoine and Nicolaides, Andrew N. and Pini, Rodolfo and Poredos, Pavel and Ricco, Jean-Baptiste and Riles, Thomas S. and Ringleb, Peter Arthur and Rundek, Tatjana and Saba, Luca and Schlachetzki, Felix and Silvestrini, Mauro and Spinelli, Francesco and Stilo, Francesco and Sultan, Sherif and Suri, Jasjit S. and Zeebregts, Clark J. and Chaturvedi, Seemant (2022) Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement. JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, 31 (1): 106182. ISSN 1052-3057, 1532-8511
Full text not available from this repository. (Request a copy)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.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | HEALTH-CARE PROFESSIONALS; PRIMARY PREVENTION; ISCHEMIC-STROKE; CEREBRAL HEMODYNAMICS; MEDICAL-TREATMENT; TASK-FORCE; GUIDELINES; ENDARTERECTOMY; SOCIETY; DISEASE; Asymptomatic carotid stenosis; Best medical treatment; Stroke; Carotid endarterectomy; Carotid plaque |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Neurologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 29 Nov 2022 06:53 |
| Last Modified: | 29 Nov 2022 06:53 |
| URI: | https://pred.uni-regensburg.de/id/eprint/48212 |
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