Asymptomatic Carotid Artery Stenosis: A Primer on Risk Stratification and Management PDF

Preface

Few topics in cardiovascular and cerebrovascular medicine generate as much controversy as the management of patients with asymptomatic carotid artery stenosis (CAS). Despite the publication of several large prospective, randomized clinical trials demonstrating the superiority of carotid endarterectomy (CEA) over medical therapy for the prevention of ischemic stroke in patients with asymptomatic CAS, some physicians remain skeptical about the value of carotid revascularization in these patients. At the crux of this attitude is the argument that the majority of these patients are at low risk for future stroke and that ‘too many' patients need to undergo carotid revascularization to prevent one stroke. The pros and cons of this argument have been – and still are – the subject of ongoing discussion.

In the meantime, rather than dismiss the dissenting opinions as illogical or unscientific, we should be seeking a constructive model for interspecialty cooperation to generate the necessary data that would improve our ability to identify asymptomatic patients who would benefit most from carotid revascularization. The literature addressing the various aspects of clinical care of patients with asymptomatic CAS is dispersed among various specialty journals (vascular surgery, neurology, neuroradiology, and cardiology); unfortunately, it is nearly impossible for a busy physician to become acquainted with it all.

This book is the product of a multispecialty effort to provide a ‘state of-the-art' review of the epidemiology, natural history, risk stratification strategies, and treatment of patients with asymptomatic CAS. The authors span the specialties of Interventional Cardiology, Neurology, Vascular Medicine, Interventional Neuroradiology and Neurosurgery. A particular emphasis is placed on clinical decision making regarding screening for asymptomatic CAS, management of patients with asymptomatic CAS prior to coronary bypass surgery, and how clinicians can use the various risk stratification strategies to guide decision making regarding the need for carotid revascularization. This effort can help better target carotid revascularization therapies towards high-risk patients and therefore improve its risk-to-benefit ratio.

We hope this book will be of interest to all healthcare professionals who are involved in the management of patients with asymptomatic CAS, including cardio - logists, neurologists, vascular surgeons, neurosurgeons, neuroradiologists, and primary care physicians. Ultimately, we hope this book will be a useful resource in the care of patients with asymptomatic CAS and will stimulate further research into the many unresolved questions.