Management of Asymptomatic Carotid Stenosis for Primary Stroke
Prevention: 2012 Focused Update of Korean Clinical Practice
Guidelines for Stroke

J Korean Neurol Assoc > Volume 30(2); 2012 > Article

Journal of the Korean Neurological Association 2012;30(2): 77-87.

무증상경동맥협착의 치료: 2012년 한국뇌졸중일차예방 진료지침 부분개정

김한영, 김성림 a 전 평 b 강현승 c 강규식 d 구자성 e 박종무 d 조용진 f 한상원 g 유경호 h 나정호 i 허지회 j 권순억 k 오창완 c 배희준 l 이병철 h 윤병우 l 홍근식 f

건국대학교 의학전문대학원 신경과학교실, 가톨릭대학교 의과대학 신경외과학교실 a , 성균관대학교 의과대학 영상의학교실 서울대학교 의과대학 신경외과학교실 c , 을지대학교 의과대학 신경과학교실 d , 가톨릭대학교 의과대학 신경과학교실 e , 인제대학교 의과대학 일산백병원 신경과학교실 f , 인제대학교 의과대학 상계백병원 신경과학교실 g , 외

Management of Asymptomatic Carotid Stenosis for Primary Stroke Prevention: 2012 Focused Update of Korean Clinical Practice Guidelines for Stroke

Hahn Young Kim

Department of Neurology, Konkuk University College of Medicine, Seoul, Korea Department of Neurosurgery a , Catholic University College of Medicine, Seoul, Korea Department of Radiology b , Sungkyunkwan University School of Medicine, Seoul, Korea Department of Neurosurgery c , Seoul National University College of Medicine, Seoul, Korea Department of Neurology d , Eulji University College of Medicine, Seoul, Korea Department of Neurology e , Catholic University College of Medicine, Seoul, Korea Department of Neurology f , Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea Department of Neurology g , Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea Department of Neurology h , Hallym University College of Medicine, Seoul, Korea Department of Neurology i , Inha University College of Medicine, Incheon, Korea Department of Neurology j , Yonsei University College of Medicine, Seoul, Korea Department of Neurology k , University of Ulsan College of Medicine, Seoul, Korea Department of Neurology l , Seoul National University College of Medicine, Seoul, Korea

Abstract

Extracranial carotid stenosis is a well-established, modifiable risk factor for stroke. Asymptomatic extracranial carotid stenosis is increasingly being detected due to the introduction of less-invasive and more-sensitive advanced diagnostic technologies. For severe asymptomatic stenosis, earlier pivotal clinical trials demonstrated the benefit of carotid endarterectomy over the best medical therapy. Since then, great advances have been made in interventional and medical therapies as well as surgical techniques. The first edition of the Korean Stroke Clinical Practice Guidelines for primary stroke prevention for the management of asymptomatic carotid stenosis reflected evidences published before June 2007. After the publication of the first edition, several major clinical trials and observational studies have been published, and major guidelines updated their recommendation. Accordingly, the writing group of Korean Stroke Clinical Practice Guidelines (CPG) decided to provide timely updated evidence-based recommendations. The Korean Stroke CPG writing committee has searched and reviewed literatures related to the management of asymptomatic carotid stenosis including published guidelines, meta-analyses, randomized clinical trials, and nonrandomized studies published between June 2007 and Feb 2011. We summarized the new evidences and revised our recommendations. Key changes in the updated guidelines are the benefit of intensive medical therapy and further evidence of carotid artery stenting as an alternative to carotid endarterectomy. The current updated guidelines underwent extensive peer review by experts from the Korean Stroke Society, Korean Society of Intravascular Neurosurgery, Korean Society of Interventional Neuroradiology, Korean Society of Cerebrovascular Surgery, and Korean Neurological Association. New evidences will be continuously reflected in future updated guidelines. Key Words: Asymptomatic carotid stenosis, Clinical practice guidelines, Primary prevention, Stroke