Known knowns, known unknowns and unknown unknowns: a 2010 update on carotid artery disease
1Department of Vascular Surgery, Clinical Sciences Building, Leicester Royal Infirmary, Leicester, UK. ross.naylor@uhl-tr.nhs.uk
Insights
Recent studies challenge established practices in carotid artery disease management. Best medical therapy and new insights may alter the interpretation of past clinical trial data, impacting future treatment guidelines.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid artery disease management remains a subject of ongoing debate and evolving research.
- Recent publications have significantly influenced discussions on diagnosis and treatment strategies.
Purpose of the Study:
- To provide a personal review of contemporary issues in carotid artery disease management.
- To assess the impact of new evidence on established guidelines and treatment paradigms.
Main Methods:
- Review of recent studies and clinical guidelines related to carotid artery disease.
- Analysis of contemporary issues including non-invasive imaging, medical therapy, and surgical interventions.
Main Results:
- Improvements in best medical therapy may question the relevance of findings from the ACAS and ACST trials.
- The role of carotid disease as a cause versus a marker for stroke risk after cardiac surgery requires further clarification.
- Current evidence on endarterectomy and stenting for symptomatic carotid disease is under review.
Conclusions:
- Established knowledge in carotid artery disease management is being re-evaluated.
- New research may shift understanding from 'known knowns' to 'known unknowns', necessitating continued investigation.
Abstract:
The management of carotid artery disease never ceases to attract controversy. The last 12 months has seen publication of a number of important studies which have informed debate and 2010 holds the prospect of much more. This update offers a personal review of a number of contemporary issues including; (i) guidelines for non-invasive imaging in rapid access clinics, (ii) whether improvements in best medical therapy have rendered many of the conclusions from ACAS and ACST obsolete, (iii) is carotid disease really just a marker for increased stroke risk following cardiac surgery (rather than being an important cause), (iv) what is the current status of endarterectomy and stenting in patients with symptomatic carotid disease and (v) why we must offer expedited interventions to TIA/minor stroke patients. The available evidence suggests that while most 'known knowns' will endure, quite a few may be returning to the category of 'known unknowns' once again. Who knows what 'unknown unknowns' await us in 2010 and beyond.
Related Concept Videos
01:27Atherosclerosis II: Clinical Manifestations and Diagnostic Tests
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and narrowing...
01:30Coronary Artery Disease I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:26Coronary Artery Disease II: Pathophysiology