TY - JOUR
T1 - Stroke risk management in carotid atherosclerotic disease
T2 - A clinical consensus statement of the ESC Council on Stroke and the ESC Working Group on Aorta and Peripheral Vascular Diseases
AU - Musialek, Piotr
AU - Bonati, Leo H.
AU - Bulbulia, Richard
AU - Halliday, Alison
AU - Bock, Birgit
AU - Capoccia, Laura
AU - Eckstein, Hans Henning
AU - Grunwald, Iris Q.
AU - Lip, Peck Lin
AU - Monteiro, Andre
AU - Paraskevas, Kosmas I.
AU - Podlasek, Anna
AU - Rantner, Barbara
AU - Rosenfield, Kenneth
AU - Siddiqui, Adnan H.
AU - Sillesen, Henrik
AU - Van Herzeele, Isabelle
AU - Guzik, Tomasz J.
AU - Mazzolai, Lucia
AU - Aboyans, Victor
AU - Lip, Gregory Y.H.
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact [email protected].
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Carotid atherosclerotic disease continues to be an important cause of stroke, often disabling or fatal. Such strokes could be largely prevented through optimal medical therapy and carotid revascularization. Advancements in discovery research and imaging along with evidence from recent pharmacology and interventional clinical trials and registries and the progress in acute stroke management have markedly expanded the knowledge base for clinical decisions in carotid stenosis. Nevertheless, there is variability in carotid-related stroke prevention and management strategies across medical specialities. Optimal patient care can be achieved by (i) establishing a unified knowledge foundation and (ii) fostering multi-specialty collaborative guidelines. The emergent Neuro-Vascular Team concept, mirroring the multi-disciplinary Heart Team, embraces diverse specializations, tailors personalized, stratified medicine approaches to individual patient needs, and integrates innovative imaging and risk-Assessment biomarkers. Proposed approach integrates collaboration of multiple specialists central to carotid artery stenosis management such as neurology, stroke medicine, cardiology, angiology, ophthalmology, vascular surgery, endovascular interventions, neuroradiology, and neurosurgery. Moreover, patient education regarding current treatment options, their risks and advantages, is pivotal, promoting patient's active role in clinical care decisions. This enables optimization of interventions ranging from lifestyle modification, carotid revascularization by stenting or endarterectomy, as well as pharmacological management including statins, novel lipid-lowering and antithrombotic strategies, and targeting inflammation and vascular dysfunction. This consensus document provides a harmonized multi-specialty approach to multi-morbidity prevention in carotid stenosis patients, based on comprehensive knowledge review, pinpointing research gaps in an evidence-based medicine approach. It aims to be a foundational tool for inter-disciplinary collaboration and prioritized patient-centric decision-making.
AB - Carotid atherosclerotic disease continues to be an important cause of stroke, often disabling or fatal. Such strokes could be largely prevented through optimal medical therapy and carotid revascularization. Advancements in discovery research and imaging along with evidence from recent pharmacology and interventional clinical trials and registries and the progress in acute stroke management have markedly expanded the knowledge base for clinical decisions in carotid stenosis. Nevertheless, there is variability in carotid-related stroke prevention and management strategies across medical specialities. Optimal patient care can be achieved by (i) establishing a unified knowledge foundation and (ii) fostering multi-specialty collaborative guidelines. The emergent Neuro-Vascular Team concept, mirroring the multi-disciplinary Heart Team, embraces diverse specializations, tailors personalized, stratified medicine approaches to individual patient needs, and integrates innovative imaging and risk-Assessment biomarkers. Proposed approach integrates collaboration of multiple specialists central to carotid artery stenosis management such as neurology, stroke medicine, cardiology, angiology, ophthalmology, vascular surgery, endovascular interventions, neuroradiology, and neurosurgery. Moreover, patient education regarding current treatment options, their risks and advantages, is pivotal, promoting patient's active role in clinical care decisions. This enables optimization of interventions ranging from lifestyle modification, carotid revascularization by stenting or endarterectomy, as well as pharmacological management including statins, novel lipid-lowering and antithrombotic strategies, and targeting inflammation and vascular dysfunction. This consensus document provides a harmonized multi-specialty approach to multi-morbidity prevention in carotid stenosis patients, based on comprehensive knowledge review, pinpointing research gaps in an evidence-based medicine approach. It aims to be a foundational tool for inter-disciplinary collaboration and prioritized patient-centric decision-making.
KW - Antithrombotic management
KW - Atherosclerotic carotid disease
KW - Biomarkers
KW - Evidence base
KW - Imaging
KW - Interventional management
KW - Multi-specialty team
KW - Neuro-Vascular team
KW - Recent trials and registries
KW - State-of-The art review
KW - Stroke risk reduction
UR - https://www.scopus.com/pages/publications/105003034522
U2 - 10.1093/cvr/cvad135
DO - 10.1093/cvr/cvad135
M3 - Review article
C2 - 37632337
AN - SCOPUS:105003034522
SN - 0008-6363
VL - 121
SP - 13
EP - 43
JO - Cardiovascular Research
JF - Cardiovascular Research
IS - 1
ER -