TY - JOUR
T1 - Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement
AU - Paraskevas, K.I.
AU - Mikhailidis, D.P.
AU - Antignani, P.L.
AU - Baradaran, H.
AU - Bokkers, R.P.H.
AU - Cambria, R.P.
AU - Dardik, A.
AU - Davies, A.H.
AU - Eckstein, H.H.
AU - Faggioli, G.
AU - Fernandes, J.F.E.
AU - Fraedrich, G.
AU - Geroulakos, G.
AU - Gloviczki, P.
AU - Golledge, J.
AU - Gupta, A.
AU - Jezovnik, M.K.
AU - Kakkos, S.K.
AU - Katsiki, N.
AU - Knoflach, M.
AU - Kooi, M.E.
AU - Lanza, G.
AU - Liapis, C.D.
AU - Loftus, I.M.
AU - Mansilha, A.
AU - Millon, A.
AU - Nicolaides, A.N.
AU - Pini, R.
AU - Poredos, P.
AU - Ricco, J.B.
AU - Riles, T.S.
AU - Ringleb, P.A.
AU - Rundek, T.
AU - Saba, L.
AU - Schlachetzki, F.
AU - Silvestrini, M.
AU - Spinelli, F.
AU - Stilo, F.
AU - Sultan, S.
AU - Suri, J.S.
AU - Zeebregts, C.J.
AU - Chaturvedi, S.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - 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)
AB - 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)
KW - Carotid stenosis
KW - Stroke
KW - Endarterectomy
KW - carotid
KW - HEALTH-CARE PROFESSIONALS
KW - CEREBRAL HEMODYNAMICS
KW - PRIMARY PREVENTION
KW - STROKE PREVENTION
KW - MEDICAL-TREATMENT
KW - ISCHEMIC-STROKE
KW - GUIDELINES
KW - ENDARTERECTOMY
KW - ASSOCIATION
KW - RECURRENCE
U2 - 10.23736/S0392-9590.21.04825-2
DO - 10.23736/S0392-9590.21.04825-2
M3 - (Systematic) Review article
C2 - 34913633
SN - 0392-9590
VL - 41
SP - 158
EP - 169
JO - International Angiology
JF - International Angiology
IS - 2
ER -