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    Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action

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    Author
    Paraskevas, Kosmas I
    Mikhailidis, 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
    Show allShow less

    Date
    2021-05-31
    Journal
    Journal of Stroke
    Publisher
    Korean Stroke Society
    Type
    Article
    
    Metadata
    Show full item record
    See at
    https://doi.org/10.5853/jos.2020.04273
    Abstract
    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 stenosis
    Endarterectomy, carotid
    Ischemic attack, transient
    Life expectancy
    Patient preference
    Stroke
    Identifier to cite or link to this item
    http://hdl.handle.net/10713/15993
    ae974a485f413a2113503eed53cd6c53
    10.5853/jos.2020.04273
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