Medical management of carotid stenosis

Perspectives in Vascular Surgery and Endovascular Therapy

Volumn 22, Issue 1, 2010, Pages 18-27

  Shields, Raymond C ^a  

^a MAYO CLINIC   (United States)

Author keywords

atherosclerotic plaque; carotid endarterectomy; carotid stenosis; medical management; stroke

Indexed keywords

ACETYLSALICYLIC ACID; ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CILOSTAZOL; CLOPIDOGREL; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; DIPYRIDAMOLE; DIURETIC AGENT; HEPARIN; HYDROXYMETHYLGLUTARYL COENZYME A REDUCTASE INHIBITOR; LOW MOLECULAR WEIGHT HEPARIN; ROSUVASTATIN; THROMBIN INHIBITOR; WARFARIN;

BLEEDING; BLOOD PRESSURE REGULATION; BRAIN ISCHEMIA; CAROTID ARTERY OBSTRUCTION; CAROTID ATHEROSCLEROSIS; CAROTID ENDARTERECTOMY; CHOLESTEROL BLOOD LEVEL; CHRONIC KIDNEY DISEASE; CIGARETTE SMOKING; CLAUDICATION; DIABETES MELLITUS; DRUG DOSE COMPARISON; DRUG MEGADOSE; DRUG POTENCY; GASTROINTESTINAL HEMORRHAGE; HUMAN; HYPERHOMOCYSTEINEMIA; HYPERLIPIDEMIA; HYPERTENSION; INFLAMMATORY CELL; LOW DRUG DOSE; MEDICAL CARE; PRIORITY JOURNAL; RECURRENT DISEASE; REVIEW; RHEUMATOID ARTHRITIS; RISK FACTOR; STROKE; SYMPTOMATOLOGY;

ASYMPTOMATIC DISEASES; CARDIOVASCULAR AGENTS; CAROTID STENOSIS; EVIDENCE-BASED MEDICINE; HUMANS; RECURRENCE; RISK ASSESSMENT; RISK FACTORS; RISK REDUCTION BEHAVIOR; SMOKING CESSATION; STROKE; TREATMENT OUTCOME;

EID: 77956255108     PISSN: 15310035     EISSN: 15310027     Source Type: Journal    
DOI: 10.1177/1531003510380929     Document Type: Review

References (91)

1. Thom T., Haase N., Rosamond W., et al. Heart disease and stroke statistics-2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published correction appears in Circulation. 2006;113:e696 and in Circulation. 2006;114:e630]. Circulation. 2006 ; 113: e85 - e151.
2. Matsumoto N., Whisnant JP, Kurland LT, Okazaki H. Natural history of stroke in Rochester, Minnesota, 1955 through 1969: an extension of a previous study, 1945 through 1954. Stroke. 1973 ; 4: 20-29.
3. Abbott AL, Bladin CF, Levi CR, Chambers BR What should we do with asymptomatic carotid stenosis ? Int J Stroke. 2007 ; 2: 27-39.
4. Bettermann KTJ. Diagnostic Evaluation and Medical Management of Patients With Ischemic Cerebrovascular Disease. 6 th ed. Philadelphia, PA: Elsevier Saunders ; 2005.
5. Pickett CA, Jackson JL, Hemann BA, Atwood JE Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet. 2008 ; 371: 1587-1594.
6. Chambers BR, Norris JW Outcome in patients with asymptomatic neck bruits. N Engl J Med. 1986 ; 315: 860-865.
7. Biller JLB, Schneck MJ Vascular Diseases of the Nervous System: Ischemic Cerebrovascular Disease. 5 th ed. Philadelphia, PA: Butterworth Heinemann Elsevier ; 2008.
8. O"™Leary DH, Anderson KM, Wolf PA, Evans JC, Poehlman HW Cholesterol and carotid atherosclerosis in older persons: the Framingham Study. Ann Epidemiol. 1992 ; 2: 147-153.
9. Bertges DJ, Muluk V., Whittle J., Kelley M., MacPherson DS, Muluk SC Relevance of carotid stenosis progression as a predictor of ischemic neurological outcomes. Arch Intern Med. 2003 ; 163: 2285-2289.
10. Muluk SC, Muluk VS, Sugimoto H., et al. Progression of asymptomatic carotid stenosis: a natural history study in 1004 patients. J Vasc Surg. 1999 ; 29: 208-214 ; discussion 214-216.
11. Garvey L., Makaroun MS, Muluk VS, Webster MW, Muluk SC Etiologic factors in progression of carotid stenosis: a 10-year study in 905 patients. J Vasc Surg. 2000 ; 31: 31-38.
12. Nagano K., Yamagami H., Tsukamoto Y., et al. Quantitative evaluation of carotid plaque echogenicity by integrated backscatter analysis: correlation with symptomatic history and histologic findings. Cerebrovasc Dis. 2008 ; 26: 578-583.
13. Lewington S., Clarke R., Qizilbash N., Peto R., Collins R. Prospective studies C. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies [published correction appears in Lancet. 2003;361:1060]. Lancet. 2002 ; 360: 1903-1913.
14. Saito D., Oka T., Kajiyama A., Ohnishi N., Shiraki T. Factors predicting compensatory vascular remodelling of the carotid artery affected by atherosclerosis. Heart. 2002 ; 87: 136-139.
15. Blann AD, Nadar S., Lip GYH. Pharmacological modulation of platelet function in hypertension. Hypertension. 2003 ; 42: 1-7.
16. Lakka TA, Salonen R., Kaplan GA, Salonen JT Blood pressure and the progression of carotid atherosclerosis in middle-aged men. Hypertension. 1999 ; 34: 51-56.
17. Sutton-Tyrrell KWS, Kuller LH Blood pressure treatment slows the progression of carotid stenosis in patients with isolated systolic hypertension. Stroke. 1994 ; 25: 44-50.
18. MacMahon S., Rodgers A. Primary and secondary prevention of stroke. Clin Exp Hypertens. 1996 ; 18: 537-546.
19. Beckett NS, Peters R., Fletcher AE, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008 ; 358: 1887-1898.
20. Ingall TJ, Homer D., Baker HL Jr, Kottke BA, O"™Fallon WM, Whisnant JP Predictors of intracranial carotid artery atherosclerosis: duration of cigarette smoking and hypertension are more powerful than serum lipid levels. Arch Neurol. 1991 ; 48: 687-691.
21. Kawachi I., Colditz GA, Stampfer MJ, et al. Smoking cessation and decreased risk of stroke in women. JAMA. 1993 ; 269: 232-236.
22. Folsom AR, Rasmussen ML, Chambless LE, et al. Prospective associations of fasting insulin, body fat distribution, and diabetes with risk of ischemic stroke. The Atherosclerosis Risk in Communities (ARIC) Study Investigators. Diabetes Care. 1999 ; 22: 1077-1083.
23. Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002 ; 287: 2570-2581.
24. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group [published correction appears in Lancet. 1998;352:1558]. Lancet. 1998 ; 352: 854-865.
25. Colhoun HM, Betteridge DJ, Durrington PN, et al. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004 ; 364: 685-696.
26. Duckworth W., Abraira C., Moritz T., et al. Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med. 2009 ; 360: 129-139.
27. Dormandy JA, Charbonnel B., Eckland DJA, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial. Lancet. 2005 ; 366: 1279-1289.
28. Skyler JS, Bergenstal R., Bonow RO, et al. Intensive glycemic control and the prevention of cardiovascular events: implications of the ACCORD, ADVANCE, and VA diabetes trials: a position statement of the American Diabetes Association and a Scientific Statement of the American College of Cardiology Foundation and the American Heart Association. J Am Coll Cardiol. 2009 ; 53: 298-304.
29. McGirt MJ, Woodworth GF, Brooke BS, et al. Hyperglycemia independently increases the risk of perioperative stroke, myocardial infarction, and death after carotid endarterectomy. Neurosurgery. 2006 ; 58: 1066-1073.
30. Shahar E., Chambless LE, Rosamond WD, et al. Plasma lipid profile and incident ischemic stroke: the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2003 ; 34: 623-631.
31. Kawamoto R., Oka Y., Tomita H., Kodama A. Non-HDL cholesterol as a predictor of carotid atherosclerosis in the elderly. J Atheroscler Thromb. 2005 ; 12: 143-148.
32. Salonen R., Seppanen K., Rauramaa R., Salonen JT Prevalence of carotid atherosclerosis and serum cholesterol levels in eastern Finland. Arteriosclerosis. 1988 ; 8: 788-792.
33. Bowman TS, Sesso HD, Ma J., et al. Cholesterol and the risk of ischemic stroke. Stroke. 2003 ; 34: 2930-2934.
34. Hebert PRP, Gaziano Jmmd, Chan KS, Hennekens Chmd. Cholesterol lowering with statin drugs, risk of stroke, and total mortality: an overview of randomized trials. JAMA. 1997 ; 278: 313-321.
35. Everett BM, Glynn RJ, MacFadyen JG, Ridker PM Rosuvastatin in the prevention of stroke among men and women with elevated levels of C-reactive protein: Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER). Circulation. 2010 ; 121: 143-150.
36. Libby P. Inflammation in atherosclerosis. Nature. 2002 ; 420: 868-874.
37. Ballantyne CM, Hoogeveen RC, Bang H., et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident ischemic stroke in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) Study. Arch Intern Med. 2005 ; 165: 2479-2484.
38. Nambi V., Hoogeveen RC, Chambless L., et al. Lipoprotein-associated phospholipase A2 and high-sensitivity C-reactive protein improve the stratification of ischemic stroke risk in the Atherosclerosis Risk in Communities (ARIC) study. Stroke. 2009 ; 40: 376-381.
39. Ridker Pmmd, Rifai NP, Pfeffer Mamd, Sacks FMD, Braunwald EMD. Long-term effects of pravastatin on plasma concentration of C-reactive protein. Circulation. 1999 ; 100: 230-235.
40. Pelisek J., Assadian A., Sarkar O., Eckstein HH, Frank H. Carotid plaque composition in chronic kidney disease: a retrospective analysis of patients undergoing carotid endarterectomy. Eur J Vasc Endovasc Surg. 2010 ; 39: 11-16.
41. Kobayashi H., Giles JT, Polak JF, et al. Increased prevalence of carotid artery atherosclerosis in rheumatoid arthritis is artery-specific. J Rheumatol. 2010 ; 37: 730-739.
42. Lanzino G., Rabinstein AA, Brown RD Jr. Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc. 2009 ; 84: 362-387 ; quiz 367-368.
43. Hobson RW II, Weiss DG, Fields WS, et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. The Veterans Affairs Cooperative Study Group. N Engl J Med. 1993 ; 328: 221-227.
44. Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995 ; 273: 1421-1428.
45. Halliday A., Mansfield A., Marro J., et al. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial [published correction appears in Lancet. 2004;364:416]. Lancet. 2004 ; 363: 1491-1502.
46. Chambers BR, Donnan G. Carotid endarterectomy for asymptomatic carotid stenosis. Cochrane Database Syst Rev. 2009 ;(4). CD001923.
47. Abbott AL Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis. Stroke. 2009 ; 40: e573 - e583.
48. Inzitari D., Eliasziw M., Gates P., et al. The causes and risk of stroke in patients with asymptomatic internal-carotid-artery stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 2000 ; 342: 1693-1700.
49. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. N Engl J Med. 1991 ; 325: 445-453.
50. Dorigo W., Pulli R., Marek J., et al. Carotid endarterectomy in female patients. J Vasc Surg. 2009 ; 50: 1301-1306 ; discussion 1306-1307.
51. Poldermans D., Bax JJ, Kertai MD, et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery. Circulation. 2003 ; 107: 1848-1851.
52. Durazzo AE, Machado FS, Ikeoka DT, et al. Reduction in cardiovascular events after vascular surgery with atorvastatin: a randomized trial. J Vasc Surg. 2004 ; 39: 967-975.
53. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels I: high-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006 ; 355: 549-559.
54. Stoney RJ, String ST Recurrent carotid stenosis. Surgery. 1976 ; 80: 705-710.
55. Sterpetti AV, Schultz RD, Feldhaus RJ, et al. Natural history of recurrent carotid artery disease. Surg Gynec B Obstet. 1989 ; 168: 217-223.
56. Moore WS, Kempczinski RF, Nelson JJ, Toole JF Recurrent carotid stenosis: results of the asymptomatic carotid atherosclerosis study. Stroke. 1998 ; 29: 2018-2025.
57. Reina-Gutierrez T., Serrano-Hernando FJ, Sanchez-Hervas L., Ponce A., Vega de Ceniga M., Martin A. Recurrent carotid artery stenosis following endarterectomy: natural history and risk factors. Eur J Vasc Endovasc Surg. 2005 ; 29: 334-341.
58. Lal BK Recurrent carotid stenosis after CEA and CAS: diagnosis and management. Semin Vasc Surg. 2007 ; 20: 259-266.
59. Dsa E., Hirschberg K., Apor A., et al. Echolucent or predominantly echolucent femoral plaques predict early restenosis after eversion carotid endarterectomy. J Vasc Surg. 2010 ; 51: 345-350.
60. Bruce AP The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007 ; 20: 252-258.
61. Glenn ML, Michael CS, David CB, et al. Determinants of carotid endarterectomy anatomic durability: Effects of serum lipids and lipid-lowering drugs. J Vasc Surg. 2005 ; 41: 762-768.
62. Groschel K., Riecker A., Schulz JB, Ernemann U., Kastrup A. Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke. 2005 ; 36: 367-373.
63. Taylor DW, Barnett HJ, Haynes RB, et al. Low-dose and high-dose acetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial. ASA and Carotid Endarterectomy (ACE) Trial Collaborators. Lancet. 1999 ; 353: 2179-2184.
64. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996 ; 348: 1329-1339.
65. Bhatt DL, Fox KAA, Hacke W., et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events. N Engl J Med. 2006 ; 354: 1706-1717.
66. McKevitt FM, Randall MS, Cleveland TJ, Gaines PA, Tan KT, Venables GS The benefits of combined anti-platelet treatment in carotid artery stenting. Eur J Vasc Endovasc Surg. 2005 ; 29: 522-527.
67. Diener HC, Cunha L., Forbes C., Sivenius J., Smets P., Lowenthal A. European Stroke Prevention Study. 2. Dipyridamole and acetylsalicylic acid in the secondary prevention of stroke. J Neurol Sci. 1996 ; 143: 1-13.
68. van Dellen D., Tiivas CAS, Jarvi K., Marshall C., Higman DJ, Imray CHE. Transcranial Doppler ultrasonography-directed intravenous glycoprotein IIb/IIIa receptor antagonist therapy to control transient cerebral microemboli before and after carotid endarterectomy. Br J Surg. 2008 ; 95: 709-713.
69. Hofmann R., Kerschner K., Steinwender C., Kypta A., Bibl D., Leisch F. Abciximab bolus injection does not reduce cerebral ischemic complications of elective carotid artery stenting: a randomized study. Stroke. 2002 ; 33: 725-727.
70. Wholey MH, Wholey MH, Eles G., et al. Evaluation of glycoprotein IIb/IIIa inhibitors in carotid angioplasty and stenting. J Endovasc Ther. 2003 ; 10: 33-41.
71. Sobel M., Verhaeghe R., American College of Chest P, American College of Chest P. Antithrombotic therapy for peripheral artery occlusive disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008 ; 133: 815S - 843S.
72. Algra A., de Schryver EL, van Gijn J., Kappelle LJ, Koudstaal PJ Oral anticoagulants versus antiplatelet therapy for preventing further vascular events after transient ischaemic attack or minor stroke of presumed arterial origin. Cochrane Database Syst Rev. 2001 ;(4). CD001342.
73. McMahon GS, Webster SE, Hayes PD, Jones CI, Goodall AH, Naylor AR Low molecular weight heparin significantly reduces embolisation after carotid endarterectomy: a randomised controlled trial. Eur J Vasc Endovasc Surg. 2009 ; 37: 633-639.
74. Staessen JA, Wang J-G., Thijs L. Cardiovascular prevention and blood pressure reduction: a quantitative overview updated until 1 March 2003. J Hypertens. 2003 ; 21: 1055-1076.
75. Dahlüf B. Prevention of stroke in patients with hypertension. Am J Cardiol. 2007 ; 100: S17 - S24.
76. Turnbull F. ; Blood Pressure Lowering Treatment Trialists "™ Collaboration. Effects of different blood-pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomised trials. Lancet. 2003 ; 362: 1527-1535.
77. The OI Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med. 2008 ; 358: 1547-1559.
78. Sever PS, Dahlüf B., Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial: Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003 ; 361: 1149-1158.
79. Miida T., Hirayama S., Nakamura Y. Cholesterol-independent effects of statins and new therapeutic targets: ischemic stroke and dementia. J Atheroscler Thromb. 2004 ; 11: 253-264.
80. Pedersen TR, Kjekshus J., Pyürala K., et al. Effect of simvastatin on ischemic signs and symptoms in the Scandinavian Simvastatin Survival Study (4S). Am J Cardiol. 1998 ; 81: 333-335.
81. Schwartz GG, Olsson AG, Ezekowitz MD, et al. Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA. 2001 ; 285: 1711-1718.
82. Hodis HN, Mack WJ, LaBree L., et al. Reduction in carotid arterial wall thickness using lovastatin and dietary therapy: a randomized controlled clinical trial. Ann Intern Med. 1996 ; 124: 548-556.
83. Yu C-M., Zhang Q., Lam L., et al. Comparison of intensive and low-dose atorvastatin therapy in the reduction of carotid intimal medial thickness in patients with coronary heart disease. Heart. 2007 ; 93: 933-939.
84. Kastelein JJP, Akdim F., Stroes ESG, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008 ; 358: 1431-1443.
85. Brown BG, Taylor AJ Does ENHANCE diminish confidence in lowering LDL or in ezetimibe ? N Engl J Med. 2008 ; 358: 1504-1507.
86. Bloomfield Rubins H., Davenport J., Babikian V., et al. Reduction in stroke with gemfibrozil in men with coronary heart disease and low HDL cholesterol: the Veterans Affairs HDL Intervention Trial (VA-HIT). Circulation. 2001 ; 103: 2828-2833.
87. Taylor AJ, Villines TC, Stanek EJ, et al. Extended-release niacin or ezetimibe and carotid intima-media thickness. N Engl J Med. 2009 ; 361: 2113-2122.
88. Corti R., Fayad ZA, Fuster V., et al. Effects of lipid-lowering by simvastatin on human atherosclerotic lesions: a longitudinal study by high-resolution, noninvasive magnetic resonance imaging. Circulation. 2001 ; 104: 249-252.
89. Blanco M., Nombela F., Castellanos M., et al. Statin treatment withdrawal in ischemic stroke: a controlled randomized study. Neurology. 2007 ; 69: 904-910.
90. Perler BA The effect of statin medications on perioperative and long-term outcomes following carotid endarterectomy or stenting. Semin Vasc Surg. 2007 ; 20: 252-258.
91. Grundy SM, Cleeman JI, Merz CNB, et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel iii guidelines. Circulation. 2004 ; 110: 227-239.