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Article Dans Une Revue International Journal of Cardiology Année : 2022

Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial

1 2CA - Central Clinic of Athens SA [Athens, Greece]
2 Robarts Research Institute [Canada]
3 Royal Free Hospital [London, UK]
4 UCL - University College of London [London]
5 NVC - Nuova Villa Claudia [Rome, Italy]
6 Mayo Clinic [Rochester]
7 MRI TUM - Klinikum rechts der Isar
8 UCBM - Università Campus Bio-Medico di Roma / University Campus Bio-Medico of Rome
9 UniCa - Università degli Studi di Cagliari = University of Cagliari
10 UMCL - University Medical Centre Ljubljana [Ljubljana, Slovenia]
11 Department of Neuroscience, Yale University School of Medicine
12 AVRC - Athens Vascular Research Center [Athens, Greece]
13 Universidade do Porto = University of Porto
14 HSJ - Hospital de S. João [Porto, Portugal]
15 UNIBO - Alma Mater Studiorum Università di Bologna = University of Bologna
16 Policlinico S. Orsola-malpighi
17 UTHealth - The University of Texas Health Science Center at Houston
18 University Hospital Galway
19 UJ - Uniwersytet Jagielloński w Krakowie = Jagiellonian University
20 UPCité - Université Paris Cité
21 HEGP - Hôpital Européen Georges Pompidou [APHP]
22 USUHS - Uniformed Services University of the Health Sciences
23 Nicolaus Copernicus University [Toruń]
24 Medical University of Warsaw - Poland
25 ULISBOA - Universidade de Lisboa = University of Lisbon
26 “Attikon” University Hospital
27 NKUA - National and Kapodistrian University of Athens
28 General University Hospital of Patras
29 Leopold Franzens Universität Innsbruck - University of Innsbruck
30 MH - Medicover Hospital [Warsaw, Poland]
31 UNIROMA - Università degli Studi di Roma "La Sapienza" = Sapienza University [Rome]
32 University of Miami
33 NWS2CFMBA - North-Western Scientific Clinical Center of Federal Medical Biological Agency [St. Petersburg, Russia]
34 UNIVPM - Polytechnic University of Marche [Ancona, Italy] / Università Politecnica delle Marche [Ancona, Italia]
35 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
36 Imperial College London
37 Atheropoint LLC Company [Roseville, CA, USA]
38 2MH - IRCSS MultiMedica Hospital [Castellanza, Italy]
39 UMCG - University Medical Center Groningen [Groningen]
40 University of Nicosia

Résumé

Background: Current guidelines do not recommend screening for asymptomatic carotid artery stenosis (AsxCS). The rationale behind this recommendation is that detection of AsxCS may lead to an unnecessary carotid intervention. In contrast, screening for abdominal aortic aneurysms is strongly recommended. Methods: A critical analysis of the literature was performed to evaluate the implications of detecting AsxCS. Results: Patients with AsxCS are at high risk for future stroke, myocardial infarction and vascular death. Population-wide screening for AsxCS should not be recommended. Additionally, screening of high-risk individuals for AsxCS with the purpose of identifying candidates for a carotid intervention is inappropriate. Instead, selective screening for AsxCS should be considered and should be viewed as an opportunity to identify individuals at high risk for atherosclerotic cardiovascular disease and future cardiovascular events for the timely initiation of intensive medical therapy and risk factor modification. Conclusions: Although mass screening should not be recommended, there are several arguments suggesting that selective screening for AsxCS should be considered. The rationale supporting such selective screening is to optimize risk factor control and to initiate intensive medical therapy for prevention of future cardiovascular events, rather than to identify candidates for an intervention.
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Dates et versions

inserm-03879459 , version 1 (30-11-2022)

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Citer

Kosmas I Paraskevas, J David Spence, Dimitri P Mikhailidis, Pier Luigi Antignani, Peter Gloviczki, et al.. Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial. International Journal of Cardiology, 2022, pp.S0167-5273(22)01394-8. ⟨10.1016/j.ijcard.2022.09.045⟩. ⟨inserm-03879459⟩

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