Optimal Management of Asymptomatic Carotid Stenosis in 2021: The Jury is Still Out. An International, Multispecialty, Expert Review and Position Statement
نویسندگان
چکیده
A multispecialty position statement based on a review of the literature. Treatment asymptomatic carotid stenosis (ACS) is controversial and includes best medical treatment (BMT) alone vs intervention plus BMT. The high-risk clinical imaging features associated with an increased long-term ipsilateral ischemic stroke risk include male patients aged <75 years, contralateral transient attack/stroke episode, intraplaque hemorrhage, impaired cerebrovascular reserve, plaque echolucency, ulceration, and/or neovascularization, lipid-rich necrotic core, ruptured fibrous cap, silent brain infarction, microembolic signals transcranial Doppler ultrasound. Increasing evidence has shown that presence 80% to 99% ACS indicates higher than 50% 79% stenoses. Several can increase future event warrant prophylactic intervention. Until results much anticipated randomized controlled trials emerge, jury still out regarding optimal ACS.
منابع مشابه
Why calls for more routine carotid stenting are currently inappropriate: an international, multispecialty, expert review and position statement.
Anne L. Abbott, MD, PhD, FRACP; Mark A. Adelman, MD; Andrei V. Alexandrov, MD; P. Alan Barber, PhD, MBChB, FRACP; Henry J.M. Barnett, CC, MD; Jonathan Beard, FRCS, ChM, MEd; Peter Bell, FRCS, MD, DSC, KBE; Martin Björck, MD, PhD; David Blacker, MD, FRACP; Leo H. Bonati, MD; Martin M. Brown, MD, FRCP; Clifford J. Buckley, MD, FACS; Richard P. Cambria, MD; John E. Castaldo, MD; Anthony J. Comerot...
متن کاملSplinting poststroke: the jury is still out.
Splinting Poststroke: the Jury Is Still Out To the Editor: In the article abstract by Lannin et al,1 the authors claim “the practice of routine splinting soon after stroke should be discontinued.” Their presented data does not show this. The stated aim was to determine the effect of splinting “on contracture in the wrist and long finger flexor muscles”1 without defining ‘contracture’. Participa...
متن کاملOptimal management of patients with asymptomatic carotid stenosis.
Prior trials have shown that carotid endarterectomy (CEA) is superior to nonoperative management of asymptomatic carotid stenosis. More recent trials have shown surprisingly better outcomes for stroke patients managed with maximal medical therapy. As such, a number of experts have called for revisiting clinical trials of both CEA and carotid stenting for patients with symptomatic and asymptomat...
متن کاملTriclocarban and Health: the Jury Is Still Out
In a recently published report, Poole et al. utilized a crossover design to determine the effect of nonprescription antimicrobial exposure on the human microbiome (1). After an initial washout phase, participants were provided either products that contained TCS or products without TCS for use over a 4-month period, followed by a switch to the opposite exposure regimen for another 4 months. Typi...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
ژورنال
عنوان ژورنال: Journal of Vascular Surgery
سال: 2022
ISSN: ['1085-875X', '0741-5214', '1097-6809']
DOI: https://doi.org/10.1016/j.jvs.2021.12.010