Management Strategies for Asymptomatic Carotid Stenosis

Abstract

Agency for Healthcare Research and Quality.

CT Angiographic Features of Symptom-Producing Plaque in Moderate-Grade Carotid Artery Stenosis

“…1 However, the validity of these data has been questioned in the years since these trials were performed secondary to recent improvements in medical therapy, which have substantially reduced annual stroke rates in patients with carotid disease. 2,3 Consequently, there has been significant recent effort to develop new imaging markers that can identify patients with carotid artery disease at highest risk for stroke beyond luminal-diameter stenosis measurements.…”

Cost-Effectiveness of Carotid Plaque MR Imaging as a Stroke Risk Stratification Tool in Asymptomatic Carotid Artery Stenosis

“…Gupta et al addition to ACST-1, include the Veterans Affairs Study published in 1993 and the Asymptomatic Carotid Atherosclerosis Study published in 1995 (12). The results of these older studies are now largely outdated, as medical of future stroke by 46% (16).…”

“…The simulated patient population was assumed to be 62.5% male (11) and 70 years of age (varied between 60 years and 80 years in sensitivity analyses) and with a mean annual risk of stroke of 1.13% on the basis of a meta-analysis of studies of asymptomatic CAS (12,13). All patients had asymptomatic 70%-89% stenosis, which could progress to an advanced category of luminal narrowing, stay in the same stenosis category, or regress to a lower stenosis category with some probability each year in the model (10,35).…”

Low Stroke Rate of Carotid Stenosis Under the Guideline-Oriented Medical Treatment Compared With Surgical Treatment

“…14) Medical treatments are continuously improving, and the recent annual stroke rate in patients with ACAS has dropped to approximately 0.3-3%. [4][5][6][7][8][9][10][11][12][13][14][15] Medical treatment is now believed to yield the best outcomes for patients with ACAS.…”

“…[1][2][3] Recently, the indications for surgical treatment using CEA or carotid artery stenting (CAS) in patients with ACAS have become controversial due to advances in medical treatment based on large studies conducted in Europe and the United States. [4][5][6][7][8][9][10][11][12][13][14][15] The clinical outcomes of medical treatment for ACAS remain largely unclear, and actual CEA outcomes may be worse than those reported in RCTs. 16) The incidence of cardiovascular events is lower in Japan than in Europe and the United States.…”