The current management of carotid atherosclerotic disease: who, when and how?

Abstract

Ischaemic stroke represents a major health hazard in the western world, which has a severe impact on society and the health-care system. Roughly, 10% of all first ischaemic strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Correct management of these lesions is essential in the prevention and treatment of carotid disease-related ischaemic events. The close relationship between diagnosis and medical and surgical management makes it necessary that all involved physicians and surgeons have profound knowledge of management strategies beyond their specific speciality. Continuous improvement in pharmacological therapy and operative techniques as well as frequently changing guidelines represent a constant challenge for the individual health-care professional. This review gives a thorough outline of the up-to-date evidence-based management of carotid artery disease and discusses its current controversies.

Calcium quantity in carotid plaques: detection in panoramic radiographs and association with degree of stenosis

“…1 Stenosis typically results from atherosclerotic plaque accumulation in the carotid artery wall, potentially leading to luminal reduction and thromboembolization. Lumen reduction of 50% or greater is especially clinically relevant.…”

“…Stroke risk can be reduced by carotid surgery and/or intensive medical treatment, but the treatment criteria and outcomes differ, depending on the presence of symptoms and the degree of luminal reduction. 1,3,4 Early diagnosis of carotid stenosis is important for reducing the risk of stroke.…”

Antiplatelet therapy for peripheral artery disease

“…The prognosis of patients with symptomatic carotid disease is significantly different from asymptomatic patients, particularly when the carotid stenosis is severe (42,43). Symptomatic patients with carotid stenosis greater than 50% have a 5-year cumulative risk >20% for ipsilateral stroke if medically treated alone (44) and this risk is higher during the first 30 days after a TIA or minor stroke: in this range of time the risk of stroke is 27% (45).…”

Antithrombotic Therapy in Carotid Artery Stenosis: An Update

“…In asymptomatic and symptomatic patients, with or without revascularization, the optimal management of carotid artery stenosis requires the use of medications or lifestyle modifications (stopping smoking and monitoring hypertension, hyperlipidemia, and diabetes) to control the processes that cause atheroma as well as the use of antiplatelet agents to reduce the risk of embolic events [14]. Regarding antithrombotic therapy, a differentiation between asymptomatic and symptomatic stenosis needs to be done.…”

“…Nonetheless, the current practice utilizes dual antiplatelet therapy prior to and after carotid stenting [14,41]. Specifically, no randomized trial is yet to compare carotid stenting with dual-antiplatelet therapy versus aspirin alone.…”