Carotid stenosis management: a review for the internist

Carmo, Gabriel Assis Lopes do; Calderaro, Daniela; Gualandro, Danielle Menosi; Casella, Ivan Benaduce; Yu, Pai Ching; Marques, Ana Paula; Caramelli, Bruno

doi:10.1007/s11739-013-1005-z

Cited by 6 publications

(4 citation statements)

References 84 publications

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“…On the other hand, it is important to know the indications based on evidences that showed favorable risk-benefit ratio and to identify all variables involved in risk estimation of this type of intervention. This is discussed in more detail in the updated version of the II Guideline for Perioperative Evaluation, with a focus on arterial vascular surgeries, which can be accessed using the link: 50 , 225 …”

Section: Interventions and Procedures With Specific Features In Thmentioning

confidence: 99%

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

Gualandro¹,

Yu²,

Caramelli³

et al. 2017

Arquivos Brasileiros De Cardiologia

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Section: Interventions and Procedures With Specific Features In Thmentioning

confidence: 99%

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

Gualandro¹,

Yu²,

Caramelli³

et al. 2017

Arquivos Brasileiros De Cardiologia

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“…Although no prospective randomized controlled trials have demonstrated a reasonable number needed to treat to make screening of carotid disease in asymptomatic patients a cost-effective mandate, current practice guidelines in the United States state that it is reasonable to conduct a carotid duplex ultrasound in patients with a bruit, symptoms of TIA, CAD, PAD, or two or more cardiovascular risk factors 36. CTA and MRA should be reserved for patients in whom duplex results are unequivocal or for preoperative planning 104–106. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease, including smoking cessation, statin therapy, antiplatelet therapy, and antihypertensive therapy 15,64.…”

Section: Resultsmentioning

confidence: 99%

Carotid revascularization: risks and benefits

O'Brien¹,

Chandra²

2014

VHRM

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Despite a decline during the recent decades in stroke-related death, the incidence of stroke has remained unchanged or slightly increased, and extracranial carotid artery stenosis is implicated in 20%–30% of all strokes. Medical therapy and risk factor modification are first-line therapies for all patients with carotid occlusive disease. Evidence for the treatment of patients with symptomatic carotid stenosis greater than 70% with either carotid artery stenting (CAS) or carotid endarterectomy (CEA) is compelling, and several trials have demonstrated a benefit to carotid revascularization in the symptomatic patient population. Asymptomatic carotid stenosis is more controversial, with the largest trials only demonstrating a 1% per year risk stroke reduction with CEA. Although there are sufficient data to advocate for aggressive medical therapy as the primary mode of treatment for asymptomatic carotid stenosis, there are also data to suggest that certain patient populations will benefit from a stroke risk reduction with carotid revascularization. In the United States, consensus and practice guidelines dictate that CEA is reasonable in patients with high-grade asymptomatic stenosis, a reasonable life expectancy, and perioperative risk of less than 3%. Regarding CAS versus CEA, the best-available evidence demonstrates no difference between the two procedures in early perioperative stroke, myocardial infarction, or death, and no difference in 4-year ipsilateral stroke risk. However, because of the higher perioperative risks of stroke in patients undergoing CAS, particularly in symptomatic, female, or elderly patients, it is difficult to recommend CAS over CEA except in populations with prohibitive cardiac risk, previous carotid surgery, or prior neck radiation. Current treatment paradigms are based on identifying the magnitude of perioperative risk in patient subsets and on using predictive factors to stratify patients with high-risk asymptomatic stenosis.

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“…The majority of the reports were related to chronically occluded internal carotid arteries. In this context, surgical vascularization is not an option 95 . According to a Cochrane review by Fluri and colleagues, bypass is neither better nor worse than medical care alone 96 .…”

Section: Discussionmentioning

confidence: 99%

“…In this context, surgical vascularization is not an option. 95 According to a Cochrane review by Fluri and colleagues, bypass is neither better nor worse than medical care alone. 96 Furthermore, COSS and RECON trials revealed no benefit for bypass over medical therapy for patients with atherosclerotic internal carotid artery occlusion with severe hemodynamic impairment.…”

Section: Managementmentioning

confidence: 99%

Limb-Shaking And Transient Ischemic Attack

Pitton Rissardo,

Fornari Caprara

2023

The Neurologist

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Background: Limb-shaking is one of the transient ischemic attacks (TIA) ‘chameleons.’ This literature review aims to evaluate the clinical, epidemiological profile, pathologic mechanisms, and management of limb-shaking TIA. Review Summary: Relevant reports in Medline’s (PubMed) database were identified and assessed by 2 reviewers without language restriction from 1985 to 2022. A total of 82 reports containing 161 cases that developed limb-shaking TIA were reported. The mean and median age were 61.36 (SD: 15.29) and 62 years (range: 4–93 y). Most of the individuals affected were males (64.34%). Limb-shaking was reported as unilateral in 83.33% of the patients. Limb-shaking presented with other neurological deficits in 44.33% of the individuals, in which the most common concurrent neurological deficit was the weakness of at least 1 limb. A recurrence of the “shaking” phenomenon was observed in 83 individuals. A trigger of limb-shaking was reported in 69 cases, and the most common was changing body position. The internal carotid artery was the most frequent vessel involved in limb-shaking. A chronically occluded internal carotid artery was observed in 42 individuals. Hypertension was the most common comorbidity. The management was conservative in 42.30% of the cases. The most frequent misdiagnoses were seizures. A full recovery was achieved in 56.60% of the individuals. Conclusions: Limb-shaking TIA could be defined as involuntary, rhythmic, brief (<5 min), recurrent, jerky movement usually precipitated by activities that may reduce cerebral blood flow. The “shaking” phenomenon was primarily described as a manifestation of symptomatic complete internal carotid artery obstruction.

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Carotid stenosis management: a review for the internist

Cited by 6 publications

References 84 publications

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

3rd GUIDELINE FOR PERIOPERATIVE CARDIOVASCULAR EVALUATION OF THE BRAZILIAN SOCIETY OF CARDIOLOGY

Carotid revascularization: risks and benefits

Limb-Shaking And Transient Ischemic Attack

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