Dokumentenart: | Artikel | ||||
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Titel eines Journals oder einer Zeitschrift: | Journal of Stroke and Cerebrovascular Diseases | ||||
Verlag: | ELSEVIER | ||||
Ort der Veröffentlichung: | AMSTERDAM | ||||
Band: | 31 | ||||
Nummer des Zeitschriftenheftes oder des Kapitels: | 1 | ||||
Seitenbereich: | S. 106182 | ||||
Datum: | 2022 | ||||
Institutionen: | Medizin > Lehrstuhl für Neurologie | ||||
Identifikationsnummer: |
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Stichwörter / 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 | ||||
Dewey-Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften > 610 Medizin | ||||
Status: | Veröffentlicht | ||||
Begutachtet: | Ja, diese Version wurde begutachtet | ||||
An der Universität Regensburg entstanden: | Ja | ||||
Dokumenten-ID: | 56922 |
Zusammenfassung
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 ...
Zusammenfassung
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.
Metadaten zuletzt geändert: 29 Feb 2024 12:42