Cerebrovascular Diseases

Therapeutic Interventions in Secondary Ischemic Stroke Prevention

Endarterectomy, Best Medical Treatment or Both for Stroke Prevention in Patients with Asymptomatic Carotid Artery Stenosis

Cardona P. · Rubio F. · Martinez-Yélamos S. · Krupinski J.

Author affiliations

Stroke Unit, Department of Neurology, Bellvitge University Hospital, IDIBELL, Barcelona, Spain

Keywords: Carotid stenosis, asymptomaticEndarterectomyAngioplasty

Related Articles for ""
Cerebrovasc Dis 2007;24:126–133
https://doi.org/10.1159/000107388

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Article / Publication Details

First-Page Preview
Abstract of Therapeutic Interventions in Secondary Ischemic Stroke Prevention

Published online: November 01, 2007
Issue release date: November 2007

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Carotid endarterectomy (CEA) is currently frequently performed in subjects with asymptomatic carotid artery stenosis over 70%, as clinical trials like the Asymptomatic Carotid Atherosclerosis Study and Asymptomatic Carotid Surgery Trial demonstrated a significant benefit for stroke prevention. A low risk reduction in the long-term prevention of stroke or death and the required lower than 3% of surgical risk are associated with surgery. That means that an important number of patients needs to be operated to prevent 1 stroke over 5 years (number needed to treat: 21) with an absolute risk reduction of 5.4%. It is reasonable to consider CEA for patients aged 40–75 years and with asymptomatic stenosis of 60–99%, for patients with a life expectancy of at least 5 years, and in centres with a surgical morbidity-mortality of less than 3%. Therefore, it is of interest to identify high-risk patients with asymptomatic carotid stenosis who will more likely benefit from surgery. Techniques such as ultrasound or magnetic resonance imaging may identify plaque morphology or detect clinically asymptomatic embolization. CEA combined with the best medical treatment and good management of modifiable risk factors might be superior to medical management alone or surgery in preventing stroke. There is no level I evidence to support carotid artery stenting in asymptomatic carotid stenosis even in a subgroup of patients with a high surgical risk.

© 2007 S. Karger AG, Basel



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Article / Publication Details

First-Page Preview
Abstract of Therapeutic Interventions in Secondary Ischemic Stroke Prevention

Published online: November 01, 2007
Issue release date: November 2007

Number of Print Pages: 8
Number of Figures: 0
Number of Tables: 1

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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2007, Vol.24, Suppl. 1

November 2007

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