asymptomatic carotid stenosis
TRANSCRIPT
Carotid revascularization in asymptomatic patients:
when should we do revascularization
Vipul Gupta
Neurointerventional Surgery/Interventional neuroradiologyMedanta The -Medicity
In favour for intervention!
• Low complication rates of revascularization• Operator experience
• Technology
• Identification of high risk patients
Now -
1% risk
European society of vascular surgery, 2013Perirocedural risk (with in 30 days) stroke/MI/death – 1 %
How to select?Identify high risk patients
•Plaque morphology
•MES
•Progression
•Silent infarcts
•Hemodynamic (VMR, degree of stenosis)
• Consecutive patients
• > 60% stenosis on doppler
• TCD – 2 MES in 1 hour
• 3D US – Ulcer detection
• Impaired vasomotor reactivity
• Cerebral blood flow patterns
JAMA 2000Breath holding index:<0.69 is impaired
Annual stroke risk - 13.9 % vs 4.1 %