Stroke risk management in carotid atherosclerotic disease: a clinical consensus statement of the ESC Council on Stroke and the ESC Working Group on Aorta and Peripheral Vascular Diseases

医学 冲程(发动机) 血管疾病 心脏病学 内科学 疾病 外围设备 动脉粥样硬化性血管病 机械工程 工程类
作者
Piotr Musiałek,Leo H. Bonati,Richard Bulbulia,Alison Halliday,Birgit Bock,Laura Capoccia,Hans‐Henning Eckstein,Iris Q. Grunwald,Peck Lin Lip,André Monteiro,Kosmas I. Paraskevas,Anna Podlasek,Barbara Rantner,Kenneth Rosenfield,Adnan H. Siddiqui,Henrik Sillesen,Isabelle Van Herzeele,Tomasz J. Guzik,Lucia Mazzolai,Victor Aboyans
出处
期刊:Cardiovascular Research [Oxford University Press]
被引量:18
标识
DOI:10.1093/cvr/cvad135
摘要

Abstract 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.
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