Management of Patients with Asymptomatic Carotid Stenosis May Need to Be Individualized: A Multidisciplinary Call for Action
Year: 2021
Type: article
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.
Source: Journal of Stroke
Authors: Kosmas I. Paraskevas, Dimitri P. Mikhailidis, Hediyeh Baradaran, Alun H. Davies, Hans-Henning Eckstein, Gianluca Faggioli, Jose Fernandes e Fernandes, Ajay Gupta, Mateja K. Jezovnik, Stavros K. Kakkos, Niki Katsiki, M. Eline Kooi, Gaetano Lanza, Christos D. Liapis, Ian M. Loftus, Antoine Millon, Andrew N. Nicolaides, Pavel Poredos, Rodolfo Pini, Jean-Baptiste Ricco, Tatjana Rundek, Luca Saba, Francesco Spinelli, Francesco Stilo, Sherif Sultan, Clark J. Zeebregts, Seemant Chaturvedi
Institutions: The Royal Free Hospital, University College London, University of Utah, Imperial College Healthcare NHS Trust, Imperial College London, TUM Klinikum, Technical University of Munich, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, University of Lisbon, Weill Cornell Medicine, The University of Texas Health Science Center at Houston, University of Patras, AHEPA University Hospital, Maastricht University Medical Centre, Maastricht University, MultiMedica, St George's, University of London, Hospices Civils de Lyon, Hôpital Louis Pradel, University of Nicosia, Ljubljana University Medical Centre, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, University of Miami, Azienda Ospedaliero-Universitaria Cagliari, Università Campus Bio-Medico, Ollscoil na Gaillimhe – University of Galway, University Hospital Galway, University Medical Center Groningen, University of Groningen, University of Maryland, Baltimore
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W3172269449