Medical management of carotid stenosis.
Stroke is a leading cause of morbidity and mortality in the developed world. Although the rates of stroke have decreased in North America, there are significant areas of risk stratification and management that can be improved. Hypertension is the most significant and perhaps most modifiable risk factor for stroke. Carotid atherosclerotic disease is associated with 15% of ischemic strokes. Although carotid endarterectomy (CEA) remains a recommendation for significant symptomatic carotid stenosis, controversy continues in the management of asymptomatic and recurrent carotid stenosis. Medical management options and effectiveness has significantly improved since the early CEA trials were published. Optimal medical management now must incorporate aggressive risk factor reduction measures, particularly with antihyperlipidemic therapy. Improved understanding of the natural history of carotid atherosclerosis is necessary to improve the application of management strategies.
Shields
Raymond C
RC
Cardiovascular Division, Mayo Clinic and Mayo Foundation, Rochester, MN 55905, USA. shields.raymond@mayo.edu
D058070:Asymptomatic Diseases; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016893:Carotid Stenosis / Q000150:complications / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
D002317:Cardiovascular Agents