Aggressive Medical Therapy Alone Is Adequate in Certain Patients With Severe Symptomatic Carotid Stenosis

Chaturvedi, Seemant

doi:10.1161/strokeaha.113.000918

Cited by 21 publications

(10 citation statements)

References 4 publications

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“…It would seem that the core elements of the SAMMPRIS regimen (antiplatelet therapy, aggressive statin use, blood pressure treatment, and lifestyle modification) are highly relevant to extracranial carotid stenosis and deserve to be tested for both asymptomatic and symptomatic stenosis patients. 30 The studies cited above (SPARCL and SAMMP-RIS) were secondary prevention studies. Although there could be uncertainty as to whether these therapies will be efficacious for asymptomatic carotid stenosis, recent observational studies also support the concept that contemporary medical therapy is having an important effect on lowering the stroke rates for patients with asymptomatic carotid stenosis (table 2).…”

Section: Prior Landmark Studies In Patients Withmentioning

confidence: 99%

The urgent need for contemporary clinical trials in patients with asymptomatic carotid stenosis

et al. 2016

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Asymptomatic extracranial internal carotid artery atherosclerotic stenosis increases with age and is more common in men. Studies performed more than 2 decades ago showed that carotid endarterectomy reduced the rate of stroke in carefully selected patients with asymptomatic carotid stenosis compared with medical therapy in the long term. Those trials were completed more than 20 years ago and with advances in the treatment of atherosclerotic disease, the question has been raised to as to whether endarterectomy is still of value for patients with asymptomatic narrowing. Perioperative risk of carotid revascularization procedures has also declined. Due to improvements in both medical and surgical treatments for carotid artery stenosis, it is timely to reevaluate the efficacy of carotid intervention relative to medical treatment for patients with asymptomatic stenosis.

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Section: Prior Landmark Studies In Patients Withmentioning

confidence: 99%

The urgent need for contemporary clinical trials in patients with asymptomatic carotid stenosis

et al. 2016

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“…In plaque analysis studies, it has been noted that women have lower macrophage staining in carotid plaques and more smooth muscle, which provides for an overall "more stable" plaque than seen in men (49). Because women were underrepresented in previous carotid stenosis trials, some have called for a future clinical trial dedicated to women with carotid stenosis (35,50).…”

Section: Selection Of Revascularization Methodsmentioning

confidence: 99%

How Recent Data Have Impacted the Treatment of Internal Carotid Artery Stenosis

Chaturvedi

Sacco

2015

Journal of the American College of Cardiology

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Carotid atherosclerosis accounts for approximately 10% of ischemic stroke cases. Multifaceted medical therapy reduces the risk of stroke in patients with carotid stenosis. Revascularization with endarterectomy or stenting can benefit select patients. In recent years, new information has been obtained regarding optimal selection of revascularization candidates. In addition, new concepts have been formulated regarding the relationship between carotid stenosis and vascular cognitive impairment. Finally, the declining rate of stroke with improved medical therapy has led to the launch of new clinical trials to determine the contemporary risk/benefit ratio of revascularization relative to aggressive medical therapy.

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“…At one year follow this study concluded that medical management with dual antiplatelet therapy was superior to PTAS and advocates belief this data can be extrapolated to severe, symptomatic extra cranial disease as well. [46,47]. Several other older studies have compared the use of platelet antiaggregants with placebo in treating patients with cerebral ischemia secondary to extra cranial atherosclerosis.…”

Section: Symptomatic Carotid Artery Stenosismentioning

confidence: 99%