From the Research
Introduction to Bilateral Carotid Artery Stenosis Management
Bilateral carotid artery stenosis of 70% is a significant condition that requires careful management to prevent stroke and other cardiovascular complications. The management of this condition involves a combination of medical therapy, lifestyle modifications, and potentially, revascularization procedures.
Medical Management
Medical management is the first line of treatment for bilateral carotid artery stenosis and involves:
- Correction of cardiovascular risk factors
- Lifestyle intervention
- Pharmacological treatment, including: + Antiplatelet therapy + Statins + ACE inhibitors As noted in the study by 1, best medical therapy is based on a tri-therapy strategy with these medications.
Revascularization Procedures
Revascularization procedures, such as carotid endarterectomy (CEA) and carotid artery stenting (CAS), may be considered for patients with bilateral carotid artery stenosis. The decision to proceed with revascularization depends on various factors, including:
- Symptomatic status
- Degree of stenosis
- Patient's medical comorbidities
- Anatomic factors As discussed in the study by 2, staged CEA with a small time interval between surgeries can be an option for highly selected patients with tandem symptomatic carotid artery stenosis.
Selection of Revascularization Procedure
The selection of revascularization procedure depends on individual patient characteristics, including:
- Anatomy (high stenosis, difficult CAS or CEA access, incomplete circle of Willis)
- Prior illness or treatment (radiotherapy, other neck surgery)
- Patient risk (unable to lie flat, poor AHA assessment) As noted in the study by 3, good outcomes can be achieved in patients with bilateral carotid artery stenosis when treatment selection is based on each individual patient's clinical characteristics.
Treatment Strategy
The treatment strategy for bilateral carotid artery stenosis of 70% involves:
- Medical management as the first line of treatment
- Revascularization procedures (CEA or CAS) for selected patients
- A multidisciplinary approach to determine the best therapeutic strategy As discussed in the study by 4, each case should be reviewed with a multidisciplinary approach to propose the best therapeutic strategy.
Future Directions
Future studies, such as the CREST-2 trial, are expected to provide level A evidence to guide treatment of asymptomatic patients with severe carotid stenosis, as noted in the study by 5. Additionally, advances in medical treatments and carotid revascularization have emerged, including transcarotid artery revascularization, which may offer new options for patients with bilateral carotid artery stenosis.