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Varna Medical Forum

Therapeutic approach in carotid atherosclerosis according to the guidelines of the European Society for Vascular Surgery

Mihael Tsalta-Mladenov, Vladina Dimitrova, Radina Fuchidzhieva, Darina Georgieva-Hristova, Silva Andonova


Atherosclerosis of the cerebral vessels is well known independent risk factor (RF) for cerebrovascular disease (CVD). Carotid artery stenosis leads to an increase in the annual risk of ischemic stroke. This tendency is more prominent in symptomatic carotid stenoses, but yet about 10-15% of all strokes in the anterior cerebral circulation are due to thromboembolism from asymptomatic carotid stenosis.

Treatment of patients with carotid atherosclerosis can be performed with best medical therapy (BMT) or revascularization treatment (RT) including carotid endarterectomy (CEA) and carotid artery stenting (CAS). The assessment of how the treatment will be conducted is done by a multidisciplinary team according to relevant criteria.

The latest international clinical practice guidelines on atherosclerotic carotid and vertebral disease of the European Society for Vascular Surgery (ESVS) from 2017,  present new recommendations for a therapeutic approach to carotid atherosclerosis. Expanded indications for conducting revascularization therapy in patients with carotid stenosis who have undergone thrombolytic therapy, and the indications for earlier conducting of revascularization procedures in patients with symptomatic and asymptomatic carotid stenosis, allows a larger number of patients to benefit from these therapeutic options. This is intended to reduce the annual risk of ischemic stroke in patients with carotid stenosis and to reduce the level of disability.

The existence of numerous recent studies and modern guidelines for the treatment of patients with symptomatic and asymptomatic carotid stenosis necessitates the update of the current recommendations for therapeutic approach for carotid extracranial pathology, which are set in the national consensus of Bulgaria.


carotid pathology, carotid atherosclerosis, therapeutic approach, recommendations

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