Best evidence for medical therapy for carotid artery stenosis.
Carotid atheromatous disease is an important cause of stroke and represents a key target in stroke prevention. Randomized trials have shown the efficacy of carotid endarterectomy in secondary stroke prevention. Carotid stenting presents a less invasive alternative to surgical intervention. Advances in medical management, if compliance can be ensured, are leading to improvement in outcomes when implemented as sole therapy in the treatment of atherosclerotic carotid stenosis. This includes lifestyle modification, blood pressure control, and antiplatelet and statin therapy. Over the last 20 years, the annual rate of ipsilateral stroke associated with asymptomatic carotid stenosis has decreased from 2% to 4% to less than 1%. This is largely due to improvements in medical therapy. However, despite numerous trials and years of clinical research, the optimal management of symptomatic and asymptomatic carotid disease remains controversial. This article presents and summarizes the evidence supporting best medical treatment for carotid artery stenosis.
Department of Vascular Surgery, Royal Free Hampstead National Health Service Trust Hospital, London, United Kingdom. Electronic address: constantinoujason@hotmail.com.
Jason
J
Constantinou
Parveen
P
Jayia
George
G
Hamilton
D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D010349:Patient Compliance; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*; D016896:Treatment Outcome
D002317:Cardiovascular Agents