Asymptomatic Carotid Artery Stenosis: Past, Present and Future

Rijbroek, A.; Wisselink, Willem; Vriens, E.M.; Barkhof, Frederik; Lammertsma, Adriaan A.; Rauwerda, J. A.

doi:10.1159/000096178

Cited by 25 publications

(12 citation statements)

References 188 publications

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“…Because carotid artery atherosclerosis can progress silently during an asymptomatic phase, its first clinical manifestation can be a debilitating or fatal stroke [1]. Treatment options for the management of carotid stenosis include surgical endarterectomy or percutaneous carotid angioplasty and stenting (both in combination with medical therapy), or medical therapy alone.…”

Section: Introductionmentioning

confidence: 99%

Asymptomatic Carotid Artery Stenosis Treated with Medical Therapy Alone: Temporal Trends and Implications for Risk Assessment and the Design of Future Studies

Hadar¹,

Raman²,

Moorthy³

et al. 2014

Cerebrovasc Dis

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Background: The rate of adverse clinical outcomes among patients with asymptomatic carotid stenosis receiving medical therapy alone can be used to guide clinical decision-making and to inform future research. We aimed to investigate temporal changes in the incidence rate of clinical outcomes among patients with asymptomatic carotid stenosis receiving medical therapy alone and to explore the implications of these changes for the design of future comparative studies. Summary: We searched MEDLINE, the Cochrane Central Register of Controlled Trials, US Food and Drug Administration documents, and reference lists of included studies (last search: December 31, 2012). We selected prospective cohort studies of medical therapy for asymptomatic carotid artery stenosis and we extracted information on study characteristics, risk of bias, and outcomes. We performed meta-analyses to estimate summary incidence rates, meta-regressions to assess trends over time, and simulations to explore sample size requirements for the design of future studies comparing new treatments against medical therapy. The main outcomes of interest were ipsilateral stroke, any stroke, cardiovascular death, death, and myocardial infarction. We identified 41 studies of medical therapy for patients with asymptomatic carotid stenosis (last recruitment year: 1978-2009). The summary incidence rate of ipsilateral carotid territory stroke (25 studies) was 1.7 per 100 person-years. This incidence rate was significantly lower in recent studies (last recruitment year from 2000 onwards) as compared to studies that ended recruitment earlier (1.0 vs. 2.3 events per 100 person-years; p < 0.001). The incidence rates of any territory stroke (17 studies), cardiovascular death (6 studies), death (13 studies), and myocardial infarction (5 studies) were 2.7, 4.1, 4.6, and 1.8 per 100 person-years, respectively. Simulations showed that future studies would need to enroll large numbers of patients with a relatively high incidence rate under medical therapy, and evaluate interventions with large effect sizes, to have adequate power to reliably detect treatment effects. Key Messages: Improved prognosis under medical therapy alone has narrowed the potential range of risk reduction attainable with new treatments for asymptomatic carotid stenosis. Future comparative studies will need to enroll large numbers of patients to assess treatment effectiveness.

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Section: Introductionmentioning

confidence: 99%

Asymptomatic Carotid Artery Stenosis Treated with Medical Therapy Alone: Temporal Trends and Implications for Risk Assessment and the Design of Future Studies

Hadar¹,

Raman²,

Moorthy³

et al. 2014

Cerebrovasc Dis

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“…При этом невро-логический дефицит и ТИА в анамнезе зачастую отсутствуют, что и обусловливает использование понятия асимптомный каротидный стеноз. По ут-верждениям ряда авторов, до 35% пациентов, пере-несших инсульт или ТИА, имели асимптомный (до момента развития сосудистого эпизода) стеноз пре-церебральных сосудов [22].…”

Section: асимптомный и интрацеребральный атеросклерозunclassified

“…Имеются данные [22] о том, что асимптомный стеноз прецеребральных сосудов является значи-мым фактором риска инсульта: при наличии асим-птомного каротидного стеноза менее 50% риск раз-вития инсульта увеличивается на 1% ежегодно, при стенозе более 50% ежегодный рост риска составляет от 5 до 10%. Вместе с тем, согласно распространен-ному в иностранной литературе мнению, рутинное дуплексное сканирование сонных артерий у паци-ентов без неврологического дефицита и ТИА в анамнезе не рекомендовано в качестве меры пер-вичной профилактики инсульта [20].…”

Section: асимптомный и интрацеребральный атеросклерозunclassified

New risk factors of stroke in young adults

Yevtushenko

Filimonov

Yevtushenko

2015

Z. nevrol. psikhiatr. im. S.S. Korsakova

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Gorky Donetsk national medical universityСогласно современным представлениям, до 75% случаев развития инсульта в общей популяции можно связать с действием общепринятых (базисных) факторов риска, таких как артериальная гипертензия, атеросклероз, нарушения ритма сердца, сахарный диабет. тем не менее до 25% случаев инсульта связано с воздействием иных факторов риска, особенно у лиц молодого возраста. в настоящем обзоре даны анализ и оценка наиболее значимых новых факторов риска развития инсульта у лиц молодого возраста, таких как генетическая предрасположенность, болезнь малых сосудов, гипергомоцистеинемия, тромбофилии, наличие «немых» инфарктов мозга и др. Акцентировано внимание на роли новых факторов риска развития инсульта у женщин. на основании современных данных литературы и личных наблюдений приводятся модифицированные критерии клинической оценки новых факторов риска. обоснован паттерн лабораторных исследований, направленных на оценку риска развития инсульта. ключевые слова: инсульт, новые факторы риска, молодой возраст.According to the modern point of view, up to 75% stroke cases may be associated with conventional (basic) risk factors such as hypertension, atherosclerosis, cardiac arrhythmia, diabetes, and others. however, up to 25% of stroke cases are associated with the influence of other risk factors, especially among young people. in this review, an analysis and evaluation of the most significant new stroke risk factors in young adults, such as genetic predisposition, «small» vessels disease, hyperhomocysteinemia, thrombophilia, «silent» brain infarction and others was made. Attention was paid to a role of new stroke risk factors in women. in this review, criteria for clinical evaluation of new stroke risk factors and pattern of laboratory tests to determine the stroke risk were defined based on current literature and personal observations. keywords: stroke, new risk factors, young age.

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“…5,25,39,61 Depending on the population studied, most short-term follow-up studies report an annual risk of unheralded ipsilateral stroke of approximately 1%-3%; within this group, higher degrees of stenosis are associated with higher risks of stroke. 5,18,26,28,39 Conversely, some studies report higher stroke rates in patients with clinically manifest atherosclerotic disease: In the Dutch Smart Study, a large prospective cohort study, 2684 consecutive patients with clinical manifestations of arterial vascular disease or Type 2 diabetes mellitus were followed after undergoing baseline carotid artery ultrasonography.…”

Section: Natural Historymentioning

confidence: 99%

Clinical considerations in the management of asymptomatic carotid artery stenosis

Taussky

Hanel

Meyer

2011

FOC

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Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.

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Asymptomatic Carotid Artery Stenosis: Past, Present and Future

Cited by 25 publications

References 188 publications

Asymptomatic Carotid Artery Stenosis Treated with Medical Therapy Alone: Temporal Trends and Implications for Risk Assessment and the Design of Future Studies

Asymptomatic Carotid Artery Stenosis Treated with Medical Therapy Alone: Temporal Trends and Implications for Risk Assessment and the Design of Future Studies

New risk factors of stroke in young adults

Clinical considerations in the management of asymptomatic carotid artery stenosis

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