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

TY - JOUR

T1 - Stroke risk management in carotid atherosclerotic disease

T2 - A clinical consensus statement of the ESC council on stroke and the ESC working group on aorta and peripheral vascular diseases

AU - Musialek, Piotr

AU - Bonati, Leo H.

AU - Bulbulia, Richard

AU - Halliday, Alison

AU - Bock, Birgit

AU - Capoccia, Laura

AU - Eckstein, Hans-Henning

AU - Grunwald, Iris Q.

AU - Lip, Peck Lin

AU - Monteiro, Andre

AU - Paraskevas, Kosmas I.

AU - Podlasek, Anna

AU - Rantner, Barbara

AU - Rosenfield, Kenneth

AU - Siddiqui, Adnan H.

AU - Sillesen, Henrik

AU - Van Herzeele, Isabelle

AU - Guzik, Tomasz J.

AU - Mazzolai, Lucia

AU - Aboyans, Victor

AU - Lip, Gregory Y. H.

N1 - Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site-for further information please contact [email protected].

PY - 2025/1

Y1 - 2025/1

N2 - 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.

AB - 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.

KW - Antithrombotic management

KW - Atherosclerotic carotid disease

KW - Biomarkers

KW - Evidence base

KW - Imaging

KW - Interventional management

KW - Multi-specialty team

KW - Neuro-Vascular team

KW - Recent trials and registries

KW - State-of-The art review

KW - Stroke risk reduction

UR - https://www.scopus.com/pages/publications/105003034522

U2 - 10.1093/cvr/cvad135

DO - 10.1093/cvr/cvad135

M3 - Article

C2 - 37632337

SN - 0008-6363

VL - 121

SP - 13

EP - 43

JO - Cardiovascular Research

JF - Cardiovascular Research

IS - 1

ER -