title: Controversies in the management of cerebrovascular disease in older patients.
abstract: Several ongoing studies are evaluating the optimal management of patients with cerebrovascular disease. The Carotid Artery Stenosis with Asymptomatic Narrowing: Operation Versus Aspirin (CASANOVA) study has shown that carotid endarterectomy is not recommended for asymptomatic patients with less than 90% carotid stenosis. The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgical Trial (ECST) have demonstrated that endarterectomy should be considered for patients who had recent carotid artery territory ischemic symptoms associated with angiographically defined stenosis of greater than 70%. These and other trials are expected to provide further data regarding management of cerebrovascular disease, including treatment of those patients with moderate (30 to 69%) carotid stenosis. Until that time, treatment decisions must be made on a case-to-case basis.
authors.affiliation: Department of Neurology, Northwestern University Medical School, Chicago.
authors.forename: J
authors.initials: J
authors.lastname: Biller
authors.forename: B B
authors.initials: BB
authors.lastname: Love
mesh_terms: D000328:Adult; D000368:Aged; D000792:Angiography; D001241:Aspirin / Q000627:therapeutic use; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D004691:Endarterectomy / Q000592:standards; D005069:Evaluation Studies as Topic; D005260:Female; D005853:Geriatrics / Q000379:methods* / Q000592:standards; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000592:standards; D014057:Tomography, X-Ray Computed; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D014859:Warfarin; D001241:Aspirin