Diagnosis of and treatment for symptomatic carotid stenosis: an updated review.

Abstract:

:Carotid stenoses of ≥50% account for about 15-20% of strokes. Their degree may be moderate (50-69%) or severe (70-99%). Current diagnostic methods include ultrasound, MR- or CT-angiography. Stenosis severity, irregular plaque surface, and presence of microembolic signals detected by transcranial Doppler predict the early recurrence risk, which may be as high as 20%. Initial therapy comprises antiplatelets and statins. Benefit of revascularization is greater in men, in older patients, and in severe stenosis; patients with moderate stenoses may also profit particularly if the plaque has an irregular aspect. An intervention should be performed within <2 weeks. In large randomized studies comparing endarterectomy and stenting, endovascular therapy was associated with a higher risk of periprocedural stroke, yet in some studies, with a lower risk of myocardial infarction and of cranial neuropathy. These trials support endarterectomy as the first choice treatment. Risk factors for each of the two therapies have been indentified: coronary artery disease, neck radiation, contralateral laryngeal nerve palsy for endarterectomy, and, elderly patients (>70 years), arch vessel tortuosity and plaques with low echogenicity on ultrasound for carotid stenting. Lastly, in direct comparisons, a contralateral occlusion increases the risk of periprocedural complications in both types of treatment.

journal_name

Acta Neurol Scand

authors

Momjian-Mayor I,Burkhard P,Murith N,Mugnai D,Yilmaz H,Narata AP,Lovblad K,Pereira V,Righini M,Bounameaux H,Sztajzel RF

doi

10.1111/j.1600-0404.2012.01672.x

subject

Has Abstract

pub_date

2012-11-01 00:00:00

pages

293-305

issue

5

eissn

0001-6314

issn

1600-0404

journal_volume

126

pub_type

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