Asymptomatic Carotid Stenosis: Intervention or Best Medical Therapy?

Abstract

Purpose of ReviewProvide a current overview regarding the optimal strategy for managing patients with asymptomatic carotid artery stenosis.Recent FindingsCarotid endarterectomy (CEA) and carotid artery stenting (CAS) reduce long-term stroke risk in asymptomatic patients. However, CAS is associated with a higher risk of peri-procedural stroke. Improvements in best medical therapy (BMT) have renewed uncertainty regarding the extent to which results from older randomised controlled trials (RCTs) comparing outcomes following carotid intervention can be generalised to modern medical practise.Summary‘Average surgical risk’ patients with an asymptomatic carotid artery stenosis of 60–99% and increased risk of late stroke should be considered for either CEA or CAS. In patients deemed ‘high risk’ for surgery, CAS is indicated. Use of an anti-platelet, anti-hypertensive and statin, with strict glycaemic control, is recommended. Results from ongoing large, multicentre RCTs comparing CEA, CAS and BMT will provide clarity regarding the optimal management of patients with asymptomatic carotid artery stenosis.

Primärprävention des Schlaganfalls

“…Die ursprünglichen randomisierten Studien, bei denen die Karotisendarteriektomie mit einer optimierten medizinischen Behandlung verglichen wurde, wurden zu einer Zeit durchgeführt, zu der keine optimale medizinische Therapie einschließlich Statine zur Verfügung stand [33]. Eine optimale Behandlung der vaskulären Risikofaktoren ist wahrscheinlich genauso wirksam wie die Karotisendarteriektomie oder das Stenting [34,35]. Eine Registerstudie aus dem VA-System in den USA fand keinen Nutzen einer Operation einer asymptomatischen Karotisstenose im Vergleich zu einer rein konservativen Therapie [36].…”

The effect of asymptomatic carotid artery stenosis on cognitive functions

“…İskemik inmelerin ise %10-15'inin nedeni karotis arter darlığıdır (1,2). KAD'nın derecesi arttıkça inme riskinin de arttığı bilinmektedir (3). Geçici iskemik atak ile başvuran hastaların ise %8-13'ünde KAD mevcuttur (4 (8,9).…”

Antiplatelet activity of new derivatives of benzimidazole containing sterically hindered phenolic group in their structure

“…Even with the constantly improving quality of life and development of the pharmaceutical industry, the number of people suffering from cardiovascular diseases is growing every day. The process of blood clotting plays one of the most important roles in the pathogenesis of ischemic disorders in various organs and tissues of the human body and, thus, making the use of antiplatelet agents and other therapies for their treatment and prevention of vital importance (Gaba et al 2018). The basic pathologies accompanied by inflammatory and atherosclerotic complications are the processes of macro-and microthrombogenesis, which can be the consequence of hyperreactivity of platelets and contribute to an increased risk of atherothrombotic events (Szabó et al 2017).…”

“…It is known that in the treatment of pathological conditions of the cardiovascular system, combination therapy is used, not only when using antiplatelet agents of various groups, but also in combination with antioxidant drugs to prevent hypoxic conditions associated with heart attacks, strokes, etc. (Szabó et al 2017, Gaba et al 2018. That is why the dual use of antiplatelet and antioxidant drugs is highly recommended nowadays in the prevention of pathogenetic development of thrombosis (Anjum et al 2018).…”