Current Therapeutic Approaches in Carotid Artery Stenosis
Clinical decisions about the management of patients with carotid stenosis have been based on the distinction between “asymptomatic” and “symptomatic” presentations since many years. Both terms, however, only address different phases of activity of the one and the same condition and blur the significant message that carotid stenosis is a most important marker of systemic atherosclerosis, which is accompanied by a much higher risk of cardiovascular events rather than stroke. As a consequence, early diagnosis and followup during best medical treatment, lifestyle management, regular cardiovascular assessment, and good control of all vascular risk factors should be recommended in all patients with carotid stenosis. Carotid stenosis amenable to surgical or interventional revascularization accounts for 5-12% of all new strokes. Duplex sonography, due to its high sensitivity and specificity is the first and the most important step in establishing the diagnosis. Several randomized trials have shown that carotid endarterectomy (CEA) for the treatment of both symptomatic and asymptomatic carotid stenosis is superior to medical treatment. Carotid artery stent application (CAS) has become comparatively safe with the use of preventive systems developed in recent years. Complication rates, at least in the patients with high surgical risks, found similar with CEA in not a few randomized trials and case studies up to now. Carotid artery stent application (CAS) can be a good alternative for many patients. More randomized studies remain awaited and needed to recommend CAS for the patients carrying low surgical risk and patients with asymptomatic stenosis.
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