Stroke risk management in carotid atherosclerotic disease: a clinical consensus statement of the ESC Council on Stroke and the ESC Working Group on Aorta and Peripheral Vascular Diseases. Musialek P, Bonati LH, Bulbulia R, et al. Stroke risk management in carotid atherosclerotic disease: A Clinical Consensus Statement of the ESC Council on Stroke and the ESC Working Group on Aorta and Peripheral Vascular Diseases. Cardiovasc Res. Aug 25 2023; doi:10.1093/cvr/cvad135

Carotid atherosclerotic disease (CarAD) is a prevalent condition worldwide, especially among the ageing population. It is a significant cause of ischemic strokes and serves as a marker for an increased risk of myocardial infarction and other ischaemic cardiovascular events. With CarAD underlying about 20% of strokes – many of which are disabling or fatal – optimal medical therapy and revascularization are crucial.

However, heterogeneity in the prevention and reperfusion management remains in clinical practice. The present consensus document addresses this issue, by providing an update on the contemporary clinical management of CarAD, synthetizing recent data from randomized trials, observational studies, and advancements in pharmacological and interventional treatments.

The authors review a range of treatment options, including lifestyle changes, long-term pharmacological therapies with a triple medical regimen (based on anti-thrombotic, anti-hypertensive, and lipid–lowering drugs), and reperfusion strategies (carotid endarterectomy or carotid artery stenting), with a focus on the respective advantages, risks, and many recent innovations, including cerebral protection, and second-generation stents.

Furthermore, Musialek et al. emphasize the importance of fostering and establishing a multi-specialty Neuro-Vascular Team. This team should include neurologists, cardiologists, angiologists, vascular surgeons, anaesthetists, and other specialists, aiming to harmonize knowledge and deliver tailored management based on each patient’s individual needs. The consensus statement also underscores the critical role of patient education and involvement in their own care. By promoting such engagement, together with a collaborative inter-disciplinary approach, optimal patient care can be achieved.

In conclusion, this consensus document serves as a valuable resource for clinicians across various specialties, enhancing and standardizing stroke prevention strategies for patients with CarAD.