Which Is The Best Treatment For Asymptomatic Carotid Stenosis

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How to identify which patients with asymptomatic carotid

Offering routine carotid endarterectomy (CEA) or carotid artery stenting (CAS) to patients with asymptomatic carotid artery stenosis (ACS) is no longer considered as the optimal management of these patients. Equally suboptimal, however, is the policy of offering only best medical treatment (BMT) to all patients with ACS and

Can risk modelling improve treatment decisions in

Keywords: Carotid endarterectomy, Asymptomatic carotid stenosis, Risk prediction Background Asymptomatic carotid endarterectomy (CEA) is com-monly performed, yet, considerable uncertainty exists about the magnitude of benefit and which patients should be treated [1]. The best estimates of the risk-

Management of atherosclerotic carotid artery disease

ing the committee s consensus regarding best practices in medical management, carotid endarterectomy, and ca-rotids stenting. RECOMMENDATION In symptomatic and asymptomatic patients with low grade carotid stenosis (stenosis 50% in symptomatic pa-tientsand 60%inasymptomaticpatients);werecommend optimal medical therapy rather than revascularization

Treatment of asymptomatic carotid stenosis

stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke. 2010; 41: e11 17. 9 Spence JD, Coates V, Li H, et al. Effects of intensive medical therapy on microemboli and cardiovascular risk in asymptomatic carotid stenosis. Arch Neurol. 2010; 67: 180 86.

U.S. task force still advises against carotid artery stenosis

treatment versus best medical treatment alone. Two fair-quality trials, two national datasets, and for asymptomatic carotid artery stenosis outweigh the benefits in the general population. This

The TAXINOMISIS Project: A multidisciplinary approach for the

Introduction: Asymptomatic carotid artery stenosis (ACAS) may cause future stroke and therefore patients with ACAS require best medical treatment. Patients at high risk for stroke may opt for additional revascularization (either surgery or stenting) but the future stroke risk should outweigh the risk for peri/post-operative stroke/death.

Carotid Stenosis: Imaging

The Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischemic Events Study (ACSRS) ‒1,115 patients with asymptomatic carotid stenosis >50% by duplex scanning for 6-84 months (mean 37.1) ‒Annual stroke rate in high-risk patients was 4.3% (vs. 0.7% in low-risk patients). ‒453 patients with 70%-99% stenosis by NASCET

Choosing Wisely® Recommendation Analysis: Prioritizing

Physicians will therefore sometimes screen asymptomatic patients for CAS as a means of convincing patients that they have a real disease and should adhere closely to all treatment recommendations (Fratt et al., 2012). Physicians feel that visual depictions of early carotid plaque can help nudge patients to take measures to control blood

REVIEW Management of asymptomatic carotid stenosis in

patients with 80 99% carotid stenosis. The results of trials assessing carotid endarter-ectomy (CEA) in patients with asymptomatic stenosis are still a matter of controversy.14 Several randomised trials have compared the efficacy and safety of CEA with best medical treatment in patients with asymptomatic carotid stenosis. A

Best medical treatment for a symptomatic carotid artery stenosis

ACST-2 trial of carotid endarterectomy vs carotid stenting), substantially un certain whether any procedure is appropriate (in which case the Best medical treatment for a symptomatic carotid artery stenosis The Asymptomatic Carotid Surgery Trial (ACST-1; Sept 25, p 1074)1 showed a reduced 10-year stroke risk for patients undergoing carotid

Patient-specific treatment allocation for carotid artery disease

5 years reported for asymptomatic patients by the Asymptomatic Carotid Surgery Trial (ACST) [11] or of 5.1% reported by the Asymptomatic Carotid Atherosclerosis Study (ACAS) [12] are very close to the 6.1% rate in our asymptomatic population. In the symptomatic population the any stroke and death rates at 3 and 5 years were

COVER STORY The Asymptomatic Carotid Stenosis Trials

tors aimed to determine whether CEA and best medical treatment (BMT) improve stroke-free survival time when compared to BMT alone. ACST is the first trial of its kind to employ a medical treatment arm. BACKGROUND Asymptomatic carotid stenosis (ACS) may be a cause of stroke. Using ultrasound technology, ACS can be accurately

Carotid Stenosis: Learning Objectives Imaging

The Asymptomatic Carotid Stenosis and Risk of Ipsilateral Hemispheric Ischemic Events Study (ACSRS) ‒1,115 patients with asymptomatic carotid stenosis >50% by duplex scanning for 6-84 months (mean 37.1) ‒Annual stroke rate in high-risk patients was 4.3% (vs. 0.7% in low-risk patients). ‒453 patients with 70%-99% stenosis by NASCET

Open access Protocol Treatment strategies for asymptomatic

Introduction Carotid endarterectomy (CEA), carotid artery stenting (CAS) and best medical therapy (BMT) are the major treatments used for significant asymptomatic carotid artery stenosis (ACAS, ≥50%). However, the widespread use of lipid- lowering drugs in this century has improved BMT outcomes. This study aims to compare the treatment efficacy of current BMT, CEA+BMT and CAS+BMT in patients with significant ACAS.

International Journal of Stroke Angioplasty in asymptomatic

Recommendations for treatment of asymptomatic carotid stenosis with carotid endarterectomy (CEA) are based on trials having recruited patients more than 15 years ago. Registry data indicate that advances in best medical treatment (BMT) may lead to a markedly decreasing risk of stroke in asymptomatic carotid stenosis.

Open Access Review Appropriate management of asymptomatic

measurement of carotid plaque volume, is promising but requires validation in randomised trials. Patients with asymptomatic carotid stenosis (ACS) have severe atherosclerosis and, besides a moderate risk of stroke, are at high risk of myocardial infarction. Although screening for asymptomatic stenosis is not jus-

Comparative Review of the Treatment Methodologies of Carotid

European Carotid Surgery Trial (ECST) have shown that symptomatic carotid stenosis greater than 70% is best treated with CEA. In asymptomatic patients with carotid stenosis greater than 60%, CEA was more beneficial than treatment with aspirin alone according to the Asymptomatic Carotid Atherosclerosis (ACAS) and Asymptomatic

Carotid endarterectomy with patch angioplasty versus primary

Jan 03, 2021 [1]. The preventive management of asymptomatic carotid ar-tery stenosis is well known, incl uding antiplatelet therapy, statins, antihypertensive medication, diabetic control, and lifestyle modifications [2 4]. Carotid endarterectomy (CEA) is the preferred guideline treatment for patients with symp-

EDITORIAL Stroke risk with symptomatic carotid stenosis

Jan 08, 2016 Ellemann K. Urgent best medical therapy may obviate the need for urgent surgery in patients with symptomatic carotid stenosis. Stroke 2013;44:2220 2225. 7. Marquardt L, Geraghty OC, Mehta Z, Rothwell PM. Low risk of ipsilateral stroke in patients with asymp-tomatic carotid stenosis on best medical treatment: a prospective, population-based study.

European Stroke Organisation guideline 2021, Vol. 6(2) I

Mar 01, 2021 (CEA) in patients with 60 99% asymptomatic carotid stenosis considered to be at increased risk of stroke on best medical treatment (BMT) alone. We also recommend CEA for patients with 70 99% symptomatic stenosis, and we

Guidelines for Screening of Extracranial Carotid Artery

The anticipated benefit of treatment in asymptomatic patients with carotid stenosis is derived from three ran-domized clinical trials. Two trials compare carotid en-darterectomy for best medical treatment in patients with asymptomatic carotid stenosis,2,3 and a third trial com-pares carotid stent placement with carotid endarterec-

Asymptomatic Carotid Artery Stenosis and the Risk of Ischemic

Background and Purpose Because best medical treatment is improving, the risk of stroke in asymptomatic carotid artery stenosis (ACAS) may decline. We evaluated the risk of ischemic stroke and stratified it according to stroke subtype in patients with ACAS during long-term follow-up.

Management of Carotid Stenosis - Tripod

with asymptomatic carotid stenosis of 70 to 80%, such as the patient in the case vignette, should be based on an understanding of the adverse events that are most likely to occur and the benefits and risks of the treatment over time. The best outcome-based data for patients with asymptomatic carotid stenosis come from

Asymptomatic carotid stenosis - crest2trial.org

Asymptomatic carotid stenosis Medicine alone or combined with carotid revascularization ABSTRACT Two positive randomized trials established carotid endarterectomy (CEA) as a superior treatment to medical management alone for the treatment of asymptomatic carotid artery stenosis. How-

Carotid Stenosis and Stroke - Health Sciences Center

Asymptomatic Carotid Stenosis with Best Medical Therapy Study Year Annualized Any Stroke Annualized Ipsilateral Stroke ACAS 1995 3.5% 2.2% ACST 2004 2.4% 1.1% ACRSR 2005 2.1% 1.7% ASED 2005 2.2% 1.0% 9 Best Medical Therapy: Smoking cessation, control of lipids, hypertension, diabetes, and use of antiplatelet therapy

Asymptomatic carotid artery stenosis: time to rethink our

Asymptomatic Carotid Artery Stenosis Two main studies have shaped the surgical treatment of asymptomatic carotid artery stenosis in the past 20 years: the Asymptomatic Carotid Atherosclerosis Study (ACAS) in North America and the Asymptomatic Ca-rotid Surgery Trial (ACST), conducted mostly in Europe.

Revascularization in Patients With Asymptomatic Carotid

Revascularization in Patients With Asymptomatic Carotid Stenosis: What is Best Practice? While awaiting for results of RCT on carotid revascularization vs. optimal medical treatment (SPACE-2, CREST-2) consider revascularization if Stenosis ≥80% (or progressive) Life expectancy ≥5 years

Clinical trial pursues best treatment options for

The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is a multi-center randomized clinical study to determine the best way to prevent strokes in people who have a high amount of blockage of their

Angiology Asymptomatic Carotid Disease and The Author(s) 2011

patientswith asymptomatic carotid disease undergoingcar-diac surgery. The natural history following best medical treatment of patients with bilateral 70% stenoses is not known. Intervention in patients requiring cardiac surgery for asymptomatic carotid artery disease can be by CEA or CAS, and a direct randomized trial comparison between

Asymptomatic carotid stenosis: screening and management

ment of asymptomatic carotid stenosis. carotid revascularization: endarterectomy or stenting The final potential treatment for as-ymptomatic carotid stenosis is the invasive option in the form of either surgical ca-rotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS). The two keystone studies comparing endar-

Screening for Asymptomatic Carotid Artery Stenosis in the

Jul 06, 2021 4 What are the harms associated with revascularization of asymptomatic carotid artery stenosis? For asymptomatic persons with carotid artery stenosis, does revascularization provide incremental benefit beyond current medical treatment? 3 Harms of screening 2 Harms of intervention 4 Asymptomatic adults Mortality Stroke Quality of life Functional and

Carotid Disease: Will ACT ONE Finally Tell Us the Best

Treatment of Asymptomatic Carotid Artery Stenosis Data for benefit of asymptomatic carotid artery stenosis revascularization is based primarily on CEA vs. medical therapy data from the 1990 s. Early risk associated with revascularization, long-term benefit over five years. No definite benefit in women (under-representation?)

Editor's Choice - Management of Atherosclerotic Carotid and

Editor s Choice e Management of Atherosclerotic Carotid and Vertebral Artery Disease: 2017 Clinical Practice Guidelines of the European Society for

Carotid Artery Disease - utoledo.edu

Asymptomatic Carotid Stenosis - Oxford Vascular Study - Marquardt L et al Stroke 2010; 41:e11 Annual Event Rate Ipsilateral stroke - 0.34% Disabling ipsilat stroke - 0% Ipsilateral TIA - 1.78% The highest risk asymptomatic patient! Carotid Artery Disease Asymptomatic Some patients with asymptomatic carotid disease will have a stroke

EDITORIAL Asymptomatic carotid stenosis

Apr 27, 2017 Asymptomatic carotid stenosis Why amoratorium isneeded onintervention outside clinical trials In this issue of Neurology®, Heck et al.1 discuss the needfor evidence regardingintervention forasymp-tomatic carotid stenosis (ACS). They say it is not proven that the risk of stroke in asymptomatic carotid stenosis is well below that of intervention.

Low Risk of Ipsilateral Stroke in Patients With Asymptomatic

Key Words: carotid stenosis stroke TIA statins T he prevalence of stenosis of the proximal carotid arteries increases from the fifth decade of life onward and affects 7% of women and 12% of men older than 70 years.1 Patients with asymptomatic carotid stenoses are at increased risk of ipsilateral carotid territory ischemic stroke2,3 and of

Patient and Provider CAROTID ARTERY STENOSIS

Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med [Internet]. 2010 Jul 1;363(1):11-23. Marquardt L, Geraghty OC, Mehta Z, Rothwell PM. Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: a prospective, population-based study. Stroke [Internet]. 2010;41

Dara G. Jamieson, M.D.

Low Risk of Ipsilateral Stroke in Patients With Asymptomatic Carotid Stenosis on Best Medical Treatment: A Prospective, Population-Based Study from 2002 to 2009. Marquardt et al, Stroke. 2010;41:e11-e17 Annual risk of ischemic stroke distal to 50% asymptomatic carotid stenosis Patients (n= 1153) with TIA/stroke in the Oxford Vascular Study,

Asymptomatic carotid artery disease: A personalized approach

Landmark trials in asymptomatic carotid stenosis ACAS1 ACST2,3 VA4 Patients 1,662 patients with asymptomatic carotid stenosis > 60% 3,120 patients with asymptomatic carotid stenosis > 60% 444 male veterans with asymptomatic carotid stenosis > 50% Exclusions Stroke in the distribution of the carotid artery under study or in that of the