carotid artery disease carotid disease

Source: EJVES Sep 2016

According to the trials, NO …. but what would you do when the plaque is ‘vulnerable’? Well … this study from Sweden for three years showed that the recurrent rate for stroke is about 7% in 3 yrs in Symptomatic mild stenosis. This is too high.

The commentary on the article put very nice rules:

A combinations of mild (20–49%) and moderate (50–69%) percent stenosis with stable or unstable plaque morphology is given in the following 2 × 2 matrix.

The four combinations for recurrent stroke risk are:

  • (a) low % stenosis and stable plaque,
  • (b) low % stenosis and unstable plaque,
  • (c) moderate % stenosis and stable plaque, and
  • (d) moderate stenosis and unstable plaque.

One might predict that

  • (a) be strongly considered for current best medical therapy and that
  • (d) be recommended for CEA.
  • The optimal management outcomes for (b) and (c) are unknown and clearly deserve a trial.
  • If I had a TIA or minor stroke and (b), mild stenosis and an unstable plaque, I would strongly consider CEA.
  • In contrast, if I had (c), moderate stenosis, and stable plaque, I might choose current best medical management, unless I was already on it.

This is really interesting argument …

 

26 Apr, 2020

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