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

Piotr Musialek (Lead / Corresponding author), Leo H. Bonati, Richard Bulbulia (Lead / Corresponding author), Alison Halliday, Birgit Bock, Laura Capoccia, Hans-Henning Eckstein, Iris Q. Grunwald, Peck Lin Lip, Andre Monteiro, Kosmas I. Paraskevas, Anna Podlasek, Barbara Rantner, Kenneth Rosenfield, Adnan H. Siddiqui, Henrik Sillesen, Isabelle Van Herzeele, Tomasz J. Guzik, Lucia Mazzolai, Victor AboyansGregory Y. H. Lip

Research output: Contribution to journalArticlepeer-review

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 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 (1) establishing a unified knowledge foundation and (2) fostering multi-specialty collaborative guidelines. The emergent Neuro-Vascular Team concept, mirroring the multi-disciplinary Heart Team, embraces diverse specializations, tailores 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, promting 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 encompassing statins, novel lipid-lowering and antithrombotic strategies and targeting inflammation and vascular dysfunction. This consensus document provides a harmonized multi-specialty approach to multimorbidity 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 interdisciplinary collaboration and prioritized patient-centric decision-making.

Original languageEnglish
JournalCardiovascular Research
Early online date25 Aug 2023
DOIs
Publication statusE-pub ahead of print - 25 Aug 2023

Keywords

  • Atherosclerotic carotid disease
  • Evidence base
  • State-of-the art review
  • Recent trials and registries
  • Stroke risk reduction
  • Imaging
  • Biomarkers
  • Antithrombotic management
  • Interventional management
  • Mutlispecialty team
  • Neuro-Vascular team

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