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Scientific article
English

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

Published inActa neurologica Scandinavica, vol. 126, no. 5, p. 293-305
Publication date2012
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.

Citation (ISO format)
MOMJIAN-MAYOR, I et al. Diagnosis of and treatment for symptomatic carotid stenosis: an updated review. In: Acta neurologica Scandinavica, 2012, vol. 126, n° 5, p. 293–305. doi: 10.1111/j.1600-0404.2012.01672.x
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