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International Angiology 2021 Jul 27

DOI: 10.23736/S0392-9590.21.04751-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Management of patients with asymptomatic carotid stenosis may need to be individualized: a multidisciplinary call for action. Republication of J Stroke 2021;23:202-212

Kosmas I. PARASKEVAS 1 , Dimitri P. MIKHAILIDIS 2, Hediyeh BARADARAN 3, Alun H. DAVIES 4, Hans-Henning ECKSTEIN 5, Gianluca FAGGIOLI 6, Jose FERNANDES E FERNANDES 7, Ajay GUPTA 8, Mateja K. JEZOVNIK 9, Stavros K. KAKKOS 10, Niki KATSIKI 11, M. Eline KOOI 12, 13, Gaetano LANZA 14, Christos D. LIAPIS 15, Ian M. LOFTUS 16, Antoine MILLON 17, Andrew N. NICOLAIDES 18, Pavel POREDOS 19, Rodolfo PINI 6, Jean-Baptiste RICCO 20, Tatjana RUNDEK 21, Luca SABA 22, Francesco SPINELLI 23, Francesco STILO 23, Sherif SULTAN 24, Clark J. ZEEBREGTS 25, Seemant CHATURVEDI 26

1 Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece; 2 Department of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK; 3 Department of Radiology, University of Utah, Salt Lake City, UT, USA; 4 Section of Vascular Surgery, Imperial College & Imperial Healthcare NHS Trust, London, UK; 5 Department of Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany; 6 Vascular Surgery, University of Bologna Alma Mater Studiorum, Policlinico S. Orsola Malpighi, Bologna, Italy; 7 Department of Vascular Surgery, Lisbon Academic Medical Center, University of Lisbon, Lisbon, Portugal; 8 Department of Radiology, Weill Cornell Medicine, New York, NY, USA; 9 Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, USA; 10 Department of Vascular Surgery, University of Patras Medical School, Patras, Greece; 11 First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece; 12 CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; 13 Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands; 14 Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Varese, Italy; 15 Athens Vascular Research Center, Athens, Greece; 16 St. George’s Vascular Institute, St. George’s University London, London, UK; 17 Department of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; 18 Department of Surgery, University of Nicosia Medical School, Nicosia, Cyprus; 19 Department of Vascular Disease, University Medical Centre Ljubljana, Ljubljana, Slovenia; 20 Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France; 21 Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA; 22 Department of Radiology, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy; 23 Vascular Surgery Division, Campus Bio-Medico University of Rome, Rome, Italy; 24 Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland; 25 Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; 26 Department of Neurology & Stroke Program, University of Maryland School of Medicine, Baltimore, MD, USA


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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.


KEY WORDS: Asymptomatic carotid stenosis; Carotid endarterectomy; Stroke; Best medical treatment

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