6
Treatment
Table 12. Asymptomatic Carotid Stenosis
Recommendations
COR LOE
Patients with asymptomatic carotid stenosis should be prescribed
daily aspirin and a statin. Patients should also be screened for other
treatable risk factors for stroke, and appropriate medical therapies and
lifestyle changes should be instituted.
I C
In patients who are to undergo CEA, aspirin is recommended
perioperatively and postoperatively unless contraindicated.
I C
It is reasonable to consider performing CEA in asymptomatic
patients who have >70% stenosis of the internal carotid artery if the
risk of perioperative stroke, MI, and death is low (<3%). However, its
effectiveness compared with contemporary best medical management
alone is not well established.
IIa A
It is reasonable to repeat duplex ultrasonography annually by
a qualified technologist in a certified laboratory to assess the
progression or regression of disease and response to therapeutic
interventions in patients with atherosclerotic stenosis >50%.
IIa C
Prophylactic CAS might be considered in highly selected patients
with asymptomatic carotid stenosis (minimum, 60% by angiography,
70% by validated Doppler ultrasound), but its effectiveness compared
with medical therapy alone in this situation is not well established.
IIb B
In asymptomatic patients at high risk of complications for carotid
revascularization by either CEA or CAS, the effectiveness of
revascularization versus medical therapy alone is not well established.
IIb B
Screening low-risk populations for asymptomatic carotid artery
stenosis is NOT recommended.
III C
Table 13. SCD
Recommendations
COR LOE
TCD screening for children with SCD is indicated starting at 2 years
of age and continuing annually to 16 years of age.
I B
Transfusion therapy (target reduction of hemoglobin S,<30%) is
effective for reducing stroke risk in those children at elevated risk.
I B
Although the optimal screening interval has not been established,
it is reasonable for younger children and those with borderline
abnormal TCD velocities to be screened more frequently to detect
the development of high-risk TCD indications for intervention.
IIa B
Pending further studies, continued transfusion, even in those whose
TCD velocities revert to normal, is probably indicated.
IIa B
In children at high risk for stroke who are unable or unwilling to be
treated with periodic red cell transfusion, it might be reasonable to
consider hydroxyurea or bone marrow transplantation.
IIb B
MRI and MRA criteria for selection of children for primary stroke
prevention with transfusion have not been established, and these tests
are NOT recommended in place of TCD for this purpose.
III B
