Identifying high-risk asymptomatic carotid stenosis
| Autor: | Robert Beanlands, Myra S Cocker, J. David Spence, Chrysi Bogiatzi |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
medicine.medical_specialty
medicine.diagnostic_test business.industry medicine.medical_treatment Biochemistry (medical) Biomedical Engineering Magnetic resonance imaging General Medicine Carotid endarterectomy medicine.disease medicine.disease_cause Asymptomatic Vulnerable plaque Transcranial Doppler Stenosis Embolus Internal medicine medicine Cardiology Molecular Medicine cardiovascular diseases Radiology medicine.symptom business Stroke |
| Zdroj: | Expert opinion on medical diagnostics. 6(2) |
| ISSN: | 1753-0067 |
| Popis: | With more intensive medical therapy, the risk of stroke in patients with asymptomatic carotid stenosis (ACS) is now below the risk of carotid endarterectomy or stenting (intervention); ∼ 90% of patients would be better with only medical therapy. It is important, therefore, to have methods to identify the ∼ 10% of patients who stand to benefit from intervention.We review the evidence that the risk of asymptomatic stenosis is now below the risk of intervention, and evidence for several approaches to identifying high-risk ACS: transcranial Doppler embolus detection, echolucency and neovascularity on ultrasound, ulceration on three-dimensional ultrasound, plaque composition on magnetic resonance imaging (MRI), plaque inflammation on positron emission tomography and assessment of cerebral blood flow reserve.Carotid endarterectomy or stenting should be performed only in patients with ACS if they have microemboli on transcranial Doppler, three or more ulcers detected on three-dimensional ultrasound or other features of unstable plaque such as plaque echolucency on ultrasound, intraplaque hemorrhage detected on MRI, inflamed plaques detected on PET/CT or reduced cerebral blood flow reserve. Most patients with ACS (∼ 90%) would be better off with intensive medical therapy than with intervention. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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