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.
Original language | English |
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Article number | 106182 |
Number of pages | 13 |
Journal | Journal of Stroke & Cerebrovascular Diseases |
Volume | 31 |
Issue number | 1 |
DOIs | |
Publication status | Published - 1 Jan 2022 |
Keywords
- Asymptomatic carotid stenosis
- Best medical treatment
- CEREBRAL HEMODYNAMICS
- Carotid endarterectomy
- Carotid plaque
- DISEASE
- ENDARTERECTOMY
- GUIDELINES
- HEALTH-CARE PROFESSIONALS
- ISCHEMIC-STROKE
- MEDICAL-TREATMENT
- PRIMARY PREVENTION
- SOCIETY
- Stroke
- TASK-FORCE
- COUNCIL