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

Abstract

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.

The Role of the Model of End-Stage Liver Disease Score in Predicting Outcomes of Carotid Endarterectomy

“…The mean number of days the creatinine, INR, and bilirubin values were collected prior to the operation were 1.2 + 0.6 (median: 1, range: 1-14), 1.1 + 0.3 days (1.1-9.5), and 1 + 0.3 days (1. [1][2][3][4][5][6][7][8][9][10][11][12][13][14], respectively.…”

“…Patients who did not have all 3 laboratory values available were not included. Our study grouped patients into 3 cohorts based on the MELD score: low (<9), moderate (9)(10)(11)(12)(13)(14), and high (15þ). This categorization is consistent with what has been used in the surgical literature.…”

The Association between Carotid Artery Atherosclerosis and Silent Brain Infarction: A Systematic Review and Meta-analysis

“…Though carotid revascularization procedures, such as endarterectomy or stenting, are indicated for those with over 70% stenosis who have clinical symptoms of stroke or transient ischemic attack (TIA) 39, 44 , it less clear whether revascularization procedures benefit patients with asymptomatic carotid stenosis 45–47 . Plaque characteristics, including ultrasound echolucency 48 and MRI features 49 , have been used to identify those atherosclerotic plaques most at risk of causing ischemic stroke.…”

Long-Term Outcomes of Carotid Artery Stenting in Clinical Practice

“…27 Current optimal medical therapy might reduce the annual stroke rate to even <1% per year. 28 However, studies reporting stroke rates ≈0.5% per year analyzed patients with only moderately severe stenoses of ≈50% to 60%. 29 The steady decline of the survival curves in the present population ( Figure I in the Data Supplement) underlines the importance of a careful risk/benefit calculation, periprocedural complication rate, and calculated life expectancy being the major determinants.…”