Management of Asymptomatic Carotid Artery Stenosis
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Vascular Disease (H Gornik and E Kim, Section Editors)
Management of Asymptomatic Carotid Artery Stenosis Marc P. Bonaca, MD, MPH* Joshua Beckman, MD, MS Address *Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA Email: [email protected]
Published online: 22 March 2013 * Springer Science+Business Media New York 2013
Keywords Carotid artery stenosis Stroke
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Atherosclerosis
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Endarterectomy
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Stent
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Transient ischemic attack
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Opinion statement Patients with atherosclerotic asymptomatic carotid artery disease are at a heightened risk of major adverse cardiovascular events including ischemic stroke. Intensive risk factor modification, including lifestyle interventions and the use of evidence based medical therapies, reduces the risk of adverse cardiovascular events in this population. Carefully selected patients with severe asymptomatic carotid stenosis may benefit from carotid endarterectomy or stenting. Patient and lesion characteristics may help to carefully select patients most likely to benefit from revascularization. Emerging therapies, including novel lipid lowering therapies, anti-platelet therapies, and anti-coagulant therapies, may further reduce the risk of adverse cardiovascular events in patients with stable atherosclerotic disease. The most important aspect of the management of asymptomatic carotid artery stenosis is reducing the overall cardiovascular risk of the patient.
Introduction Significant stenosis of the carotid artery is defined as a 9 50 % luminal narrowing of the vessel. Atherosclerotic vascular disease characterized by lipid plaque and calcification is the most common cause of carotid artery stenosis, however, other causes such as dissection, fibromuscular dysplasia and inflammation may also result in luminal narrowing. Most commonly, carotid artery stenosis occurs at the carotid bifurcation and may involve the common carotid artery, the internal carotid artery, and the external carotid artery. The primary concern associated with carotid artery stenosis is the devel-
opment of progressive narrowing, thrombosis or unstable plaque in the common or internal carotid artery that may lead to downstream ischemia and stroke. Importantly, the risk of such events depends on the stability of the stenosis manifested as either symptomatic or asymptomatic disease. This review will focus on the management of patients with stable or asymptomatic atherosclerotic carotid artery stenosis. Patients with stable carotid atherosclerosis are at a heightened risk of atherothrombotic events, including cardiovascular death, myocardial infarction, and stroke
Management of Asymptomatic Carotid Artery Stenosis
Bonaca and Beckman
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Figure 1. The patient with asymptomatic carotid artery disease is at risk of stroke, as well as other major adverse cardiovascular events. Appropriate management includes comprehensive lifestyle and medical interventions to reduce the overall risk of cardiovascular events. Decisions regarding intervention for the stenosis re
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