Background: Medical therapy for asymptomatic carotid artery stenosis (ACAS) may obviate the carotid revascularization, according to recent literature reports, but many studies also considered moderate carotid artery stenosis (50â69% NASCET). This study reviews the most recent series of ACAS focusing on ipsilateral transient ischemic attack (TIA) stroke and annual risk of stroke in patients with ACAS â¥70%, thereby also evaluating the adherence to best medical therapy (BMT). Methods: A systematic review consisting of all the series of patients with ACAS being treated medically was performed, which was published after 2005. The annual pooled risk of ipsilateral TIA-stroke and stroke in patients with ACAS â¥70% was calculated. A subgroup of studies with BMT defined as â¥90% of the patients in antiplatelet and statin therapy was performed. Results: Eleven studies, with the enrolling period from 1996 to 2009, were reviewed. Overall, 2185 patients were considered, with a follow-up from 2 to 13 years, for a total of 6834 patients/year. The pooled risk was 3.4%/year for ipsilateral TIA-stroke and 1.6%/year for stroke. Five studies, published from 2014, had BMT adherence, for a total of 1665 patients/year. The pooled risk was 3.5%/year for ipsilateral TIA-stroke and for stroke. Conclusion: The most recent series of ACAS â¥70% and BMT had an overall stroke rate which is relatively low; however, the risk of developing symptoms is still relevant (3.4%/year).
The fate of asymptomatic severe carotid stenosis in the era of best medical therapy / Pini, Rodolfo; Faggioli, Gianluca; Vacirca, Andrea; Cacioppa, Laura Maria; Gallitto, Enrico; Gargiulo, Mauro; Stella, Andrea. - In: BRAIN INJURY. - ISSN 0269-9052. - STAMPA. - 31:13-14(2017), pp. 1711-1717. [10.1080/02699052.2017.1346285]
The fate of asymptomatic severe carotid stenosis in the era of best medical therapy
Pini, Rodolfo;Faggioli, Gianluca;Vacirca, Andrea;Cacioppa, Laura Maria;Gallitto, Enrico;Gargiulo, Mauro;Stella, Andrea
2017
Abstract
Background: Medical therapy for asymptomatic carotid artery stenosis (ACAS) may obviate the carotid revascularization, according to recent literature reports, but many studies also considered moderate carotid artery stenosis (50â69% NASCET). This study reviews the most recent series of ACAS focusing on ipsilateral transient ischemic attack (TIA) stroke and annual risk of stroke in patients with ACAS â¥70%, thereby also evaluating the adherence to best medical therapy (BMT). Methods: A systematic review consisting of all the series of patients with ACAS being treated medically was performed, which was published after 2005. The annual pooled risk of ipsilateral TIA-stroke and stroke in patients with ACAS â¥70% was calculated. A subgroup of studies with BMT defined as â¥90% of the patients in antiplatelet and statin therapy was performed. Results: Eleven studies, with the enrolling period from 1996 to 2009, were reviewed. Overall, 2185 patients were considered, with a follow-up from 2 to 13 years, for a total of 6834 patients/year. The pooled risk was 3.4%/year for ipsilateral TIA-stroke and 1.6%/year for stroke. Five studies, published from 2014, had BMT adherence, for a total of 1665 patients/year. The pooled risk was 3.5%/year for ipsilateral TIA-stroke and for stroke. Conclusion: The most recent series of ACAS â¥70% and BMT had an overall stroke rate which is relatively low; however, the risk of developing symptoms is still relevant (3.4%/year).I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.