Optimal management of asymptomatic carotid stenosis in 2021: the jury is still out. An international, multispecialty, expert review and position statement

Journal Publication ResearchOnline@JCU
Paraskevas, K.I.;Mikhailidis, D.P.;Antignani, P.L.;Baradaran, H.;Bokkers, R.P.H.;Cambria, R.P.;Dardik, A.;Davies, A.H.;Eckstein, H.H.;Faggioli, G.;Fernandes E Fernandes, J.;Fraedrich, G.;Geroulakos, G.;Gloviczki, P.;Golledge, J.;Gupta, A.;Jezovnik, M.K.;Kakkos, S.K.;Katsiki, N.;Knoflach, M.;Kooi, M.E.;Lanza, G.;Liapis, C.D.;Loftus, I.M.;Mansilha, A.;Millon, A.;Nicolaides, A.N.;Pini, R.;Poredos, P.;Ricco, J.B.;Riles, T.S.;Ringleb, P.A.;Rundek, T.;Saba, L.;Schlachetzki, F.;Silvestrini, M.;Spinelli, F.;Stilo, F.;Sultan, S.;Suri, J.S.;Zeebregts, C.J.;Chaturvedi, S.
Jonathan Golledge
Abstract

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.

Journal

International Angiology

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N/A

Volume

41

ISBN/ISSN

03929590

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Publish Date

01 Apr 2022

Url

https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85128245171&origin=inward

Date

N/A

EISSN

18271839

DOI

10.23736/S0392-9590.21.04825-2