Key result
Carotid endarterectomy remains first-line over stenting for symptomatic >50% stenosis alongside DAPT and high-dose statins.
Why the study?
Advances in medical pharmacotherapy have implications for the relative benefit of surgery for symptomatic carotid atherosclerosis and for the approach to asymptomatic disease.
This review summarizes current evidence on the medical and surgical management of carotid atherosclerosis, emphasizing the evolving role of advanced pharmacotherapy and the clinical importance of high-risk plaque features beyond simple luminal stenosis.
Supports CEA preference with DAPT and high-dose statins for symptomatic stenosis; leaves open prospective validation with contemporary regimens.
Internal carotid artery atherosclerosis is a major risk factor for stroke, accounting for 15-20% of ischaemic strokes. Revascularisation procedures-either carotid endarterectomy or carotid artery stenting-can reduce the risk of stroke for those with significant (>50%) luminal stenosis but particularly for those with more severe (70-99%) stenosis. However, advances in medical pharmacotherapy have implications for the relative benefit from surgery for symptomatic carotid atherosclerosis, as well as our approach to asymptomatic disease. This review considers the evidence underpinning the current medical and surgical management of symptomatic carotid atherosclerosis, the importance of factors beyond the degree of luminal stenosis, and developments in therapeutic strategies. We also discuss the importance of non-stenotic but high-risk carotid atherosclerotic plaques on the cause of stroke, and their implications for clinical practice.
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Evans et al. (2024) conducted a review in Carotid Atherosclerosis. Carotid endarterectomy, carotid artery stenting, and medical therapy was evaluated. Carotid endarterectomy remains the recommended first-line treatment over carotid artery stenting for symptomatic >50% stenosis, while best medical therapy now comprises dual antiplatelet therapy and high-dose statins.
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