Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

Kosmas Paraskevas*, Dimitri P. Mikhailidis, Hediyeh Baradaran, Alun H. Davies, Hans-Henning Eckstein, Gianluca Faggioli, Jose Fernandes E. Fernandes, Ajay Gupta, Mateja K. Jezovnik, Stavros K. Kakkos, Niki Katsiki, M. Eline Kooi, Gaetano Lanza, Christos D. Liapis, Ian M. Loftus, Antoine Millon, Andrew N. Nicolaides, Pavel Poredos, Rodolfo Pini, Jean-Baptiste RiccoTatjana Rundek, Luca Saba, Francesco Spinelli, Francesco Stilo, Sherif Sultan, Clark J. Zeebregts, Seemant Chaturvedi

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

10 Citations (Web of Science)

Abstract

The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are 5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.

Original languageEnglish
Pages (from-to)202-212
Number of pages11
JournalJournal of Stroke
Volume23
Issue number2
DOIs
Publication statusPublished - May 2021

Keywords

  • Endarterectomy
  • carotid
  • Carotid stenosis
  • Stroke
  • Ischemic attack
  • transient
  • Patient preference
  • Life expectancy
  • STROKE PREVENTION
  • ARTERY STENOSIS
  • PERSONALIZED-MEDICINE
  • VASCULAR-SURGERY
  • SCORING SYSTEM
  • ENDARTERECTOMY
  • RISK
  • SURVIVAL
  • OUTCOMES
  • MORTALITY

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