Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action
Author
Paraskevas, Kosmas IMikhailidis, Dimitri P
Baradaran, Hediyeh
Davies, Alun H
Eckstein, Hans-Henning
Faggioli, Gianluca
Fernandes, Jose Fernandes E
Gupta, Ajay
Jezovnik, Mateja K
Kakkos, Stavros K
Katsiki, Niki
Kooi, M Eline
Lanza, Gaetano
Liapis, Christos D
Loftus, Ian M
Millon, Antoine
Nicolaides, Andrew N
Poredos, Pavel
Pini, Rodolfo
Ricco, Jean-Baptiste
Rundek, Tatjana
Saba, Luca
Spinelli, Francesco
Stilo, Francesco
Sultan, Sherif
Zeebregts, Clark J
Chaturvedi, Seemant
Date
2021-05-31Journal
Journal of StrokePublisher
Korean Stroke SocietyType
Article
Metadata
Show full item recordAbstract
The optimal management of patients with asymptomatic carotid stenosis (ACS) is the subject of extensive debate. According to the 2017 European Society for Vascular Surgery guidelines, carotid endarterectomy should (Class IIa; Level of Evidence: B) or carotid artery stenting may be considered (Class IIb; Level of Evidence: B) in the presence of one or more clinical/imaging characteristics that may be associated with an increased risk of late ipsilateral stroke (e.g., silent embolic infarcts on brain computed tomography/magnetic resonance imaging, progression in the severity of ACS, a history of contralateral transient ischemic attack/stroke, microemboli detection on transcranial Doppler, etc.), provided documented perioperative stroke/death rates are <3% and the patient's life expectancy is >5 years. Besides these clinical/imaging characteristics, there are additional individual, ethnic/racial or social factors that should probably be evaluated in the decision process regarding the optimal management of these patients, such as individual patient needs/patient choice, patient compliance with best medical treatment, patient sex, culture, race/ethnicity, age and comorbidities, as well as improvements in imaging/operative techniques/outcomes. The present multispecialty position paper will present the rationale why the management of patients with ACS may need to be individualized.Keyword
Carotid stenosisEndarterectomy, carotid
Ischemic attack, transient
Life expectancy
Patient preference
Stroke
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http://hdl.handle.net/10713/15993ae974a485f413a2113503eed53cd6c53
10.5853/jos.2020.04273
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