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Diagnosis and Management of Large Artery Atherosclerosis

Seemant Chaturvedi

    Continuum (Minneapolis, Minn.)
    |April 11, 2023
    PubMed

    Insights

    Advances in medical therapies improve stroke prevention for large vessel atherosclerosis. While dual antiplatelet therapy is recommended, the role of revascularization remains debated, especially for asymptomatic carotid stenosis.

    Area of Science:

    • Neurology
    • Cardiovascular Medicine
    • Vascular Surgery

    Background:

    • Ischemic stroke caused by large vessel atherosclerosis is a major global health concern.
    • The aging population is projected to increase the incidence of atherosclerotic stroke.
    • Extracranial and intracranial atherosclerotic disease require ongoing research for effective management.

    Approach:

    • This review synthesizes recent advancements in the assessment and treatment of large vessel atherosclerosis.
    • It examines updated therapeutic strategies, including dual antiplatelet therapy and risk factor control.
    • The article discusses the evolving role of revascularization procedures.

    Key Points:

    • Intensive dual antiplatelet therapy is now recommended for transient ischemic attack and stroke patients.
    • Stringent blood pressure and lipid management are advised.
    • High-resolution carotid plaque imaging is gaining importance.

    Conclusions:

    • Medical therapy advancements have enhanced stroke prevention for large vessel atherosclerosis.
    • The necessity of carotid revascularization is decreasing due to improved medical treatments.
    • The role of revascularization for asymptomatic carotid stenosis is controversial, while symptomatic intracranial stenosis warrants intensive medical therapy.
    Abstract

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