Management of carotid stenosis for primary and secondary prevention of stroke: state-of-the-art 2020: a critical review.

摘要: Carotid atherosclerotic plaque is encountered frequently in patients at high cardiovascular risk, especially the elderly. When reaches 50% of carotid lumen, it induces haemodynamically significant stenosis, for which management currently a turning point. Improved control blood pressure, smoking ban campaigns, and widespread use statins have reduced risk cerebral infarction to 50%; asymptomatic patients: tight stenosis (>60%) perceived long-term stroke (determined mainly by imaging criteria). Choice procedure may be influenced anatomy (high difficult CAS or CEA access, incomplete circle Willis), prior illness treatment (radiotherapy, other neck surgery), patient (unable lie flat, poor AHA assessment). In conclusion, neither systematic nor abandoned, place revascularization must necessarily limited plaques highest leaving large optimized medical as first line management. An evaluation value performing endarterectomy on considered underway ACTRIS CREST 2 studies. These studies, along with next result ACST-2 trial, will provide us more precise strategy case stenosis.