Carotid stenosis – basing treatment on individual patients’ needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy

Abstract

Summary:Though carotid artery stenosis is a known origin of stroke, risk assessment and treatment modality are not yet satisfactorily established. Guideline updates according to latest evidence are expected shortly. Current clinical weakness concerns in particular the identifi cation of "at-risk" patients. Beside the symptomatic status and the degree of stenosis, further signs of unstable plaque on carotid and cerebral imaging should be considered. Moreover, medical and endovascular therapy are continuously improving. Randomized trials and meta-analyses have shown similar long-term results for protected carotid artery stenting and endarterectomy. However, endovascular revascularization was associated with an increased 30-day rate of minor strokes. Newly developed embolic protection devices could possibly compensate for this disadvantage. Furthermore, high-level optimal medical therapy alone is currently being evaluated comparatively. We assume that a comprehensive evaluation of plaque vulnerability, serious consideration of advanced embolic protection, and more space for optimal medical therapy alone according to latest evidence, will benefi t patients with carotid stenosis.Keywords: Carotid artery stenosis, carotid artery stenting, carotid endarterectomy, optimal medical therapy Risk of strokeIn neurologically symptomatic patients with carotid artery stenosis, in particular in those with a recent stroke or transient ischaemic attack (TIA), severe atherosclerosis is known to be associated with a high risk of recurrent stroke. In a recently published study [2], the recurrence rate of ipsilateral ischaemic stroke in patients with a degree of 50-99 % stenosis increased from 2.7 % within the fi rst day, to 5.3 % within three days, to 11.5 % within 14 days and fi nally to 18.8 % within 90 days after occurrence of neurologic symptoms. Advanced age and cerebral vs. ocular symptoms were associated with a higher recurrence rate. The survey did not reveal associations between the recurrence of neurological events and the degree of stenosis, additional vascular risk factors or medication. However, a large pooled data analysis [3] on symptomatic patients showed an increased benefi t from endarterectomy compared to medical treatment alone,

Pre-Procedural Statin Use Is Associated with Improved Long-Term Survival and Reduced Major Cardiovascular Events in Patients Undergoing Carotid Artery Stenting: A Retrospective Study

“…Nevertheless, CAS is a less invasive intervention than surgical endarterectomy and more appealing for patients at elevated surgical risk such as the elderly and/or patients with important comorbidities. This study suggests that an optimization of drug therapy before CAS might improve procedure effectiveness [ 25 ]. In this regard, a randomized controlled trial with high dose rosuvastatin on peri-procedural complications in dyslipidemic patients who undergo CAS procedure is ongoing and will provide important information in the next years [ 26 ].…”

The Possibilities of Using a New Fixed-Dose Combination of Rosuvastatin and Acetylsalicylic Acid: Focus Groups of Patients

“…Атеросклеротическое поражение сонных артерий представляет собой одну из наиболее частых причин ишемического инсульта (ИИ) [3]. Примерно треть всех острых клинически значимых окклюзий мозговых со-судов вызваны атеросклерозом экcтракраниального отдела каротидных артерий [3], а еще 10% связаны непосредственно с атеросклерозом самих внутриче-репных сосудов [4].…”

“…Примерно треть всех острых клинически значимых окклюзий мозговых со-судов вызваны атеросклерозом экcтракраниального отдела каротидных артерий [3], а еще 10% связаны непосредственно с атеросклерозом самих внутриче-репных сосудов [4]. В России ежегодно регистрируется от 200 до 500 случаев заболевания инсультом на 100000 населения [5].…”

Carotid Artery Angioplasty and Stenting for Carotid Stenosis: A Single-Center Experience from Saudi Arabia

“…Worldwide, atherosclerotic stenosis of the extracranial carotid artery accounts for approximately 20% of all strokes with no statistics or data coming from Saudi Arabia [ 3 ]. The diagnosis and treatment of carotid artery disease have improved significantly over the past 2 decades with the emergence of medical treatment and carotid revascularization procedures [ 4 ]. Both carotid artery endarterectomy (CEA) and carotid artery angioplasty with stenting (CAAS) are recommended for symptomatic patients with 50% or more stenosis or asymptomatic patients with 70% or more stenosis [ 5 ].…”