From the Research
Introduction to Bilateral Carotid Artery Stenosis Management
Bilateral carotid artery stenosis of moderate severity, such as 65% stenosis, poses a significant risk for stroke and requires careful management. The approach to managing this condition involves a combination of medical therapy, lifestyle modifications, and potentially, surgical or endovascular interventions.
Medical Management
Medical management is a cornerstone in the treatment of bilateral carotid artery stenosis, focusing on reducing the risk of stroke and managing cardiovascular risk factors. This approach includes:
- Correction of cardiovascular risk factors
- Lifestyle intervention
- Pharmacological treatment with:
- Antiplatelet agents
- Statins
- ACE inhibitors
As noted in 1, medical management is always warranted and applied to any patient with atheromatous lesions, with the goal of reducing the risk of stroke.
Surgical and Endovascular Options
For patients with symptomatic carotid stenosis, carotid endarterectomy (CEA) and carotid artery stenting (CAS) are considered. The choice between these procedures depends on various factors, including the patient's anatomy, prior illnesses, and risk profile.
- CEA is recommended for symptomatic patients with moderate to severe carotid stenosis (>50%) and for asymptomatic patients with severe carotid stenosis (>60%) when the perioperative risk is low, as suggested in 2.
- CAS may be considered as an alternative to CEA in symptomatic patients with high perioperative risk or in cases where CEA is not feasible.
Considerations for Bilateral Carotid Artery Stenosis
In cases of bilateral carotid artery stenosis, the management strategy must be tailored to the individual patient, taking into account the severity of stenosis, symptoms, and overall risk profile. Staged procedures, such as staged CEA, may be an option for highly selected patients, as reported in 3.
Conclusion
The management of bilateral carotid artery stenosis of moderate severity involves a multidisciplinary approach, incorporating medical therapy, lifestyle modifications, and potentially, surgical or endovascular interventions. The decision-making process should be guided by the latest clinical guidelines and evidence, including considerations for the patient's specific risk factors, symptoms, and anatomical characteristics, as discussed in 4, 5, 1, 3, 2.