Management of transient ischemic attack or nondisabling stroke related to extracranial internal carotid artery stenosis

Cerebrovascular disease is not only the third largest cause of death in Canada, it is also associated with substantial functional morbidity after an event. In 2013, over 400 000 Canadians were living with the disabling effects of a stroke, most of which were due to ischemic injury. Symptoms usually...

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Bibliographic Details
Published inCanadian Medical Association journal (CMAJ) Vol. 191; no. 15; pp. E418 - E422
Main Authors Kapila, Varun, Jetty, Prasad, Basile, Vincenzo S., Dubois, Luc
Format Journal Article
LanguageEnglish
Published Canada Elsevier Inc 15.04.2019
CMA Impact, Inc
Joule Inc
Subjects
Amino Acids - therapeutic use
Carotid arteries
Carotid Arteries - pathology
Carotid Stenosis - complications
Carotid Stenosis - surgery
Collaboration
Disease management
Disease prevention
Endarterectomy, Carotid
Humans
Internal Medicine
Intervention
Ischemia
Ischemic Attack, Transient - etiology
Ischemic Attack, Transient - prevention & control
Platelet Aggregation Inhibitors - therapeutic use
Randomized Controlled Trials as Topic
Review
Stroke
Stroke - etiology
Stroke - prevention & control
Surgery
Systematic review
Transient ischemic attack
Veins & arteries
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Summary:Cerebrovascular disease is not only the third largest cause of death in Canada, it is also associated with substantial functional morbidity after an event. In 2013, over 400 000 Canadians were living with the disabling effects of a stroke, most of which were due to ischemic injury. Symptoms usually occur because of atherosclerotic plaque rupture in the internal carotid artery and embolization of plaque particles to the brain, which leads to transient or persistent ischemia in a specific anatomic area and related neurologic symptoms. Population-based studies have suggested a high risk of recurrent transient ischemic attack or stroke after an index event from a moderate to severe stenosis of the extracranial internal carotid artery, ranging from 10% to 20% within the next 90 days. Here, Kapila et al review the medical and surgical management of patients with symptomatic extracranial internal carotid artery stenosis, focusing on recent guidelines, large trials and meta-analyses, and highlighting recent evidence supporting early carotid intervention.
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ISSN:0820-3946
1488-2329
1488-2329
DOI:10.1503/cmaj.180735