; Mikhailidis, Dimitri P. ; Antignani, Pier Luigi ; Baradaran, Hediyeh
; Bokkers, Reinoud P.H.
; Cambria, Richard P. ; Dardik, Alan ; Davies, Alun H. ; Eckstein, Hans-Henning ; Faggioli, Gianluca ; e Fernandes, Jose Fernandes ; Fraedrich, Gustav ; Geroulakos, George ; Gloviczki, Peter ; Golledge, Jonathan ; Gupta, Ajay ; Jezovnik, Mateja K. ; Kakkos, Stavros K. ; Katsiki, Niki ; Knoflach, Michael
; Kooi, M. Eline ; Lanza, Gaetano ; Liapis, Christos D. ; Loftus, Ian M. ; Mansilha, Armando ; Millon, Antoine ; Nicolaides, Andrew N. ; Pini, Rodolfo ; Poredos, Pavel ; Ricco, Jean-Baptiste ; Riles, Thomas S. ; Ringleb, Peter Arthur ; Rundek, Tatjana ; Saba, Luca ; Schlachetzki, Felix ; Silvestrini, Mauro ; Spinelli, Francesco
; Stilo, Francesco ; Sultan, Sherif ; Suri, Jasjit S. ; Zeebregts, Clark J. ; Chaturvedi, Seemant | Item type: | Article | ||||
|---|---|---|---|---|---|
| Journal or Publication Title: | Journal of Stroke and Cerebrovascular Diseases | ||||
| Publisher: | Elsevier | ||||
| Place of Publication: | AMSTERDAM | ||||
| Volume: | 31 | ||||
| Number of Issue or Book Chapter: | 1 | ||||
| Page Range: | p. 106182 | ||||
| Date: | 2022 | ||||
| Institutions: | Medicine > Lehrstuhl für Neurologie | ||||
| Identification Number: |
| ||||
| 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 Decimal Classification: | 600 Technology > 610 Medical sciences Medicine | ||||
| Status: | Published | ||||
| Refereed: | Yes, this version has been refereed | ||||
| Created at the University of Regensburg: | Yes | ||||
| Item ID: | 56922 |
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 ...

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.
Metadata last modified: 29 Feb 2024 12:42
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