An increased risk of ipsilateral cerebrovascular events has also been reported over a mean follow-up period of 38.2 months in asymptomatic

patients who had 50–79% carotid stenosis and the presence of a thin or ruptured fibrous cap, intraplaque hemorrhage, or a larger lipid-rich necrotic core [23]. At this time there are no published prospective population data to evaluate the role of MRI findings in risk assessment of asymptomatic adults. A number of large-scale studies are ongoing [21]. Patients with ACS have a high overall vascular risk. A cardiac workup and an optimal treatment of vascular risk factors should be done. “
“Arterioarterial embolism is one of the most common stroke etiologies. Although screening for carotid artery disease Ganetespib chemical structure in patients with lack of symptoms of cerebrovascular disease on

a routine base is not recommended, these patients are identified in many ways, particularly by a general physician, who examines the origin of a carotid bruit or by an angiologist screening for additional manifestations of arteriosclerosis in patients with peripheral arterial occlusive signaling pathway disease. When asymptomatic carotid stenosis is diagnosed, operative treatment of carotid stenosis is well established since results of the Asymptomatic Carotid Atherosclerosis Study (ACAS) trial [1] and the Asymptomatic Carotid Surgery Trial (ACST) [2] were published. However, due to low absolute risk reduction of 1.2% the efficacy of surgical intervention has been questioned by means of calculations leading to a disclosure of costs of up to 580.000 AUS$ for one stroke prevented with prophylactic TEA in case of asymptomatic stenosis

[3]. Costs may be even higher, taking into account, that the periprocedural complication rate of less than 3% in the multicenters trials was not confirmed in postapproval registries [4] and [5]. A recent meta analysis went even further and calculated Lenvatinib molecular weight the difference in estimated fatal and disabling stroke-free survival in case of endarterectomy in patients with asymptomatic severe carotid stenosis as less than 4 days over the course of 5 years [6]. Rate for ipsilateral stroke in untreated carotid stenosis has been declined from 3.3% [7] in 1985 to 0.6% [8] in 2007. A recent meta analysis concluded, that this observation was not due to reduced incidence of risk factors but rather due to improved medical treatment (particularly hypertensive drugs and statines) [9]. At least for high-risk asymptomatic patients with poor 5-year survival (e.g., those with previous vascular surgery, claudication, cardiac disease, an abnormal electrocardiogram, diabetes mellitus, or older age) medical treatment was recommended since many years [10].