Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement

2022 ◽  
Vol 31 (1) ◽  
pp. 106182
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Pier Luigi Antignani ◽  
Hediyeh Baradaran ◽  
Reinoud P.H. Bokkers ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Position Statement ◽  
Optimal Management ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Expert Review

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

2021 ◽  
Author(s):  
Kosmas I. PARASKEVAS ◽  
Dimitri P. MIKHAILIDIS ◽  
Pier Luigi ANTIGNANI ◽  
Hediyeh BARADARAN ◽  
Reinoud P. BOKKERS ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Position Statement ◽  
Optimal Management ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Expert Review

scholarly journals The painstaking search for the optimal management of patients with asymptomatic carotid stenosis

2021 ◽  
Vol 73 (5) ◽  
pp. 1834-1835
Author(s):  
Kosmas I. Paraskevas ◽  
Jean-Baptiste Ricco ◽  
Ali F. AbuRahma ◽  
Enrico Ascher ◽  
Frank J. Veith
Keyword(s):  
Carotid Stenosis ◽  
Optimal Management ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid

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

2021 ◽  
Vol 23 (2) ◽  
pp. 202-212
Author(s):  
Kosmas I. Paraskevas ◽  
Dimitri P. Mikhailidis ◽  
Hediyeh Baradaran ◽  
Alun H. Davies ◽  
Hans-Henning Eckstein ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Patient Choice ◽  
Optimal Management ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Level Of Evidence ◽  
Clinical Imaging ◽  
Imaging Characteristics ◽  
Best Medical Treatment ◽  
Increased Risk

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.

scholarly journals The analysis of the connection between plaque morphology of the asymptomatic carotid stenosis and ischemic brain lesions

2013 ◽  
Vol 70 (11) ◽  
pp. 993-998 ◽  
Author(s):  
Djordje Milosevic ◽  
Janko Pasternak ◽  
Vladan Popovic ◽  
Dragan Nikolic ◽  
Pavle Milosevic ◽  
...  
Keyword(s):  
Risk Factors ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Brain Infarction ◽  
Statistical Significance ◽  
Brain Parenchyma ◽  
Plaque Morphology ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Silent Brain Infarction

Background/Aim. A certain percentage of patients with asymptomatic carotid stenosis have an unstable carotid plaque. For these patients it is possible to register by modern imaging methods the existence of lesions of the brain parenchyma - the silent brain infarction. These patients have a greater risk of ischemic stroke. The aim of this study was to analyze the connection between the morphology of atherosclerotic carotid plaque in patients with asymptomatic carotid stenosis and the manifestation of silent brain infarction, and to analyze the influence of risk factors for cardiovascular diseases on the occurrence of silent brain infarction and the morphology of carotid plaque. Methods. This retrospective study included patients who had been operated for high grade (> 70%) extracranial atherosclerotic carotid stenosis at the Clinic for Vascular and Transplantation Surgery of the Clinical Center of Vojvodina over a period of 5 years. The patients analyzed had no clinical manifestation of cerebrovascular insufficiency of the carotid artery territory up to the time of operation. The classification of carotid plaque morphology was carried out according to the Gray-Weale classification, after which all the types were subcategorized into two groups: stable and unstable. Brain lesions were verified using preoperative imaging of the brain parenchyma by magnetic resonance. We analyzed ipsilateral lesions of the size > or = 3 mm. Results. Out of a 201 patients 78% had stable plaque and 22% unstable one. Unstable plaque was prevalent in the male patients (male/female ratio = 24.8% : 17.8%), but without a statistically significant difference (p > 0.05). The risk factors (hypertension, nicotinism, hyperlipoproteinemia, and diabetes mellitus) showed no statistically significant impact on carotid plaque morphology and the occurrence of silent brain infarction. Silent brain infarction was detected in 30.8% of the patients. Unstable carotid plaque was found in a larger percentage of patients with silent brain infarction (36.4% : 29.3%) but without a significant statistical difference (p > 0.05). Conclusions. Even though silent brain infarction is more frequent in patients with unstable plaque of carotid bifurication, the difference is of no statistical significance. The effects of the number and type of risk factors bear no statistical significance on the incidence of morphological asymptomatic carotid plaque.

scholarly journals COATED-PLATELETS ENHANCE TIA/STROKE RISK PREDICTION IN ASYMPTOMATIC CAROTID STENOSIS PATIENTS FOLLOWED WITH CAROTID DOPPLER SURVEILLANCE

2021 ◽  
Vol 77 (18) ◽  
pp. 1817
Author(s):  
Mohamad Khattab ◽  
Arleen Ramirez-Jimenez ◽  
Andrea Vincent ◽  
George Dale ◽  
Calin Prodan ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Risk Prediction ◽  
Stroke Risk ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Carotid Doppler
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