Asymptomatic carotid artery stenosis: who should be screened, who should be treated and how should we treat them?

Abstract

Although stopping smoking, lowering blood pressure and reducing lipid levels will reduce global stroke risk and cardiovascular mortality, these remain leading causes of death and disability especially in ageing populations. Further prevention strategies are needed and, in the first part of this review, we explore the potential benefits of appropriate screening for carotid artery disease to reduce stroke and identify those who may have related cardiac disease. Although whole-population carotid screening is an inefficient and costly means of identifying candidates with tight carotid stenosis who might warrant intervention, it can identify many people with lower levels of stenosis who may benefit from cardiovascular riskreducing medications. Longer-term benefits and cost-effectiveness of any targeted screening programme needs further evaluation.Patients with carotid stenosis are known to be at increased risk of stroke and vascular death.Whilst randomised clinical trials and guidelines have reported stroke hazards and benefits of interventional treatment for carotid stenosis, uncertainty remains about their optimal medical management. In the second part of this review we discuss Level I evidence for medical and surgical treatment of asymptomatic carotid stenosis, reasons for the current lack of consensus on interventional management of these patients and future studies which may help to clarify which groups will (and which will likely not) benefit from interventions.

Carotid artery screening in high risk asymptomatic individuals: outcomes of 3000 carotid screening

“…There are no randomized control trials to compare the benefits of screening vs. no screening in the general population and the effect on rates of stroke and cardiovascular disease. Study suggests both medical and surgical interventions to reduce the risk of stroke in asymptomatic patients be effective 11 Nevertheless, the biggest problem is who will be screened 12 . In our study, we defined five more common modifiable risk factors among our population as inclusion criteria.…”

An Ultrasound Model to Predict the Short-Term Effects of Endovascular Stent Placement in the Treatment of Carotid Artery Stenosis

“…The Report on the Prevention and Treatment of Stroke in China (2016) revealed that the prevalence of stroke in China increased from 0.4% in 1993 to 1.23% in 2013. The prevalence has continued to increase in recent years and stroke has become a critical disease that seriously impedes socio-economic development due to its high incidence, high recurrence rate, and high disability rate (16,17).…”

In vitro analysis of carotid lesions using a preliminary microwave sensor to detect vulnerable plaques: Correlation with histology, Duplex ultrasound examination, and computed tomography scanner: The Imaging and Microwave Phenotyping Assessment of Carotid stenosis Threat (IMPACT) study

“…Philips US system Affiniti 70, L12-5 50 mm Linear Probe transducer was used. The Grey-Weale updated scale 28 , 29 , 30 , 31 , 32 and color Doppler imaging were used to characterize the carotid plaque. Peak systolic and end-diastolic velocities, and internal carotid artery/common carotid artery ratio, were registered.…”