Strategies for asymptomatic carotid artery stenosis

The treatment of asymptomatic carotid artery stenosis (ACAS) has continued to evolve for the past 3 decades. With rapidly advancing technology, the results of old trials have become obsolete. While there has been little change in the efficacy of carotid endarterectomy, there have been vast improvements in both medical management and carotid angioplasty with stenting. Finding the best therapy for a given patient can therefore be difficult. In this article, the authors review the current literature regarding treatment options for ACAS and the methods available for stratifying patients who would benefit from surgical versus medical treatment.

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In Patients with Asymptomatic Carotid Artery Stenosis Does Current Best Medical Management Reduce the Risk of Stroke Compared to Intervention (Endarterectomy or Stent)?

Difficult Decisions in Surgery: An Evidence-Based Approach - Difficult Decisions in Vascular Surgery ◽

10.1007/978-3-319-33293-2_26 ◽

2017 ◽

pp. 311-320

Author(s):

James R. Brorson

Keyword(s):

Carotid Artery ◽

Medical Management ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

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Carotid Endarterectomy for Asymptomatic Carotid Artery Stenosis – Can We Predict Who will Need Intensive Unit Post-operative Care?

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2019.06.1102 ◽

2019 ◽

Vol 58 (6) ◽

pp. e447-e448

Author(s):

Andreia P. Coelho ◽

Miguel Lobo ◽

Ricardo Gouveia ◽

Clara Nogueira ◽

Jacinta Campos ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Operative Care ◽

Asymptomatic Carotid Artery Stenosis

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Efficacy of Contemporary Medical Management for Asymptomatic Carotid Artery Stenosis

The American Surgeon ◽

10.1177/000313481307901006 ◽

2013 ◽

Vol 79 (10) ◽

pp. 987-991

Author(s):

Jason Chang ◽

Joseph E. Ahn ◽

Nicholas Landsman ◽

Katherine Rhee ◽

Linda Chun ◽

...

Keyword(s):

Carotid Artery ◽

Medical Management ◽

Carotid Artery Stenosis ◽

Stroke Prevention ◽

International Classification Of Diseases ◽

Artery Stenosis ◽

Published Data ◽

Asymptomatic Carotid ◽

Kaiser Permanente ◽

Asymptomatic Carotid Artery Stenosis

In the Asymptomatic Carotid Artery Stenosis trial (1995), medical management was defined as aspirin in addition to adequate control of comorbidities. Since then, medical management of asymptomatic carotid artery stenosis (CAS) has progressed to include broader use of statins. Our purpose was to review the effect of contemporary medical management on stroke prevention. A retrospective review of the Kaiser Permanente, Southern California medical group database was performed. All patients with a diagnosis of asymptomatic CAS by International Classification of Diseases, 9th Revision codes from 2007 to 2011 were identified. Intervention for stroke prevention was the criteria for exclusion. Medications used were evaluated as was the rate of stroke. Asymptomatic CAS was noted in 7255 patients. Of these, 158 (2.2%) sustained a stroke within a mean follow-up of 37 months. Patients who were taking a statin had a statistically significant lower risk of stroke (1.6 vs 3.9%). The data support that contemporary medical management of asymptomatic CAS has decreased the incidence of stroke in comparison to previously published data. The use of statins was protective against the development of stroke. Future prospective randomized trials are needed to evaluate the efficacy of carotid intervention versus current medical management.

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Medical Management of Asymptomatic Carotid Artery Stenosis

Progress in Cardiovascular Diseases ◽

10.1016/j.pcad.2017.05.008 ◽

2017 ◽

Vol 59 (6) ◽

pp. 585-590 ◽

Cited By ~ 8

Author(s):

Aaron W. Aday ◽

Joshua A. Beckman

Keyword(s):

Carotid Artery ◽

Medical Management ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Asymptomatic Carotid ◽

Asymptomatic Carotid Artery Stenosis

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Asymptomatic carotid artery stenosis: time to rethink our therapeutic options?

Neurosurgical FOCUS ◽

10.3171/2013.10.focus13389 ◽

2014 ◽

Vol 36 (1) ◽

pp. E2 ◽

Cited By ~ 10

Author(s):

Saul F. Morales-Valero ◽

Giuseppe Lanzino

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Medical Therapy ◽

Carotid Artery Stenosis ◽

Large Scale ◽

Artery Stenosis ◽

Invasive Treatment ◽

Asymptomatic Carotid ◽

Potential Benefits ◽

Asymptomatic Carotid Artery Stenosis

Asymptomatic carotid artery stenosis is a well-recognized risk factor for ischemic stroke, and its prevalence increases with age. In the late 1980s and in the 1990s, well-designed randomized trials established a definite advantage for carotid endarterectomy in reducing the risk of ipsilateral stroke when compared with medical therapy alone. However, medical treatment of cardiovascular disease has improved significantly over the past 2 decades, and this has, in turn, resulted in a decline of the stroke risk in patients with asymptomatic carotid artery stenosis treated medically. This improvement in medical therapy casts doubts on the effectiveness of large-scale invasive treatment in patients with asymptomatic carotid artery stenosis. Several studies have been conducted to identify possible subgroups of patients with asymptomatic stenosis who are at higher risk of stroke in order to maximize the potential benefits of invasive treatment. Ongoing large-scale trials comparing best current medical therapy to available invasive treatments, such as carotid endarterectomy and carotid artery stenting, are likely to shed some light on this debated topic in the near future. In this review, the authors summarize the current controversy surrounding the ideal management of asymptomatic carotid artery stenosis.

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