Update in the treatment of extracranial atherosclerotic disease for stroke prevention

Stroke Vasc Neurol. 2019 Nov 7;5(1):65-70. doi: 10.1136/svn-2019-000261. eCollection 2020.

Abstract

Stroke is a leading cause of adult mortality and disability worldwide. Extracranial atherosclerotic disease (ECAD), primarily, carotid artery stenosis, accounts for approximately 18%-25% of ischaemic stroke. Recent advances in neuroimaging, medical therapy and interventional management have led to A significant reduction of stroke from carotid artery stenosis. The current treatment of ECAD includes optimal medical therapy, carotid endarterectomy (CEA) and carotid artery stenting (CAS). The selection of treatments depends on symptomatic status, severity of stenosis, individual factors, efficacy and risk of complications. The aim of this paper is to review current evidence and guidelines on the management of carotid artery stenosis, including the comparison of medical and interventional therapy (CAS and CEA), as well as future directions.

Keywords: atherosclerosis; intervention; stroke.

Publication types

  • Review

MeSH terms

  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / mortality
  • Brain Ischemia / physiopathology
  • Brain Ischemia / prevention & control*
  • Cardiovascular Agents / adverse effects
  • Cardiovascular Agents / therapeutic use*
  • Carotid Stenosis / diagnostic imaging
  • Carotid Stenosis / mortality
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / therapy*
  • Clinical Decision-Making
  • Endarterectomy, Carotid* / adverse effects
  • Endarterectomy, Carotid* / mortality
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / instrumentation
  • Endovascular Procedures* / mortality
  • Humans
  • Risk Assessment
  • Risk Factors
  • Risk Reduction Behavior*
  • Severity of Illness Index
  • Stents
  • Stroke / diagnostic imaging
  • Stroke / mortality
  • Stroke / physiopathology
  • Stroke / prevention & control*
  • Treatment Outcome

Substances

  • Cardiovascular Agents