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Screening for high-grade asymptomatic carotid artery stenosis in nonvalvular atrial fibrillation

Published:November 04, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.11.004
      The plea for screening for asymptomatic carotid artery stenosis [
      • Paraskevas K.I.
      • Spence J.D.
      • Mikhailidis D.P.
      • Antignani P.L.
      • Gloviczki P.
      • Eckstein H.-H.
      • et al.
      Why do guidelines recommend screening for abdominal aortic aneurysms, but not for asymptomatic carotid stenosis? A plea for a randomized controlled trial.
      ] should be extended to patients with the association of asymptomatic carotid artery stenosis (CAS) and nonvalvular atrial fibrillation(NVAF). The rationale is that it is already recognised that high-grade CAS(stenosis of 50% or more) is prevalent in about 12% of NVAF patients aged >70 [
      • Kanter M.C.
      • Tegeler C.H.
      • Pearce L.A.
      • Weinberger J.
      • Feinberg W.M.
      • Anderson D.C.
      • et al.
      Carotid stenosis in patients with atrial fibrillation.
      ]. Furthermore, in a study where 103 consecutive ischemic stroke patients with NVAF and were screened for CAS, high-grade extracranial CAS was identified in 25 subjects. All 103 subjects had undergone validation of cerebral infarcts by computed tomography. In 15 subjects with high-grade CAS, the CAS lesion was ipsilateral to the cerebral infarct [
      • Chang Y.-J.
      • Ryu S.-J.
      • Lin S.-K.
      Carotid artery stenosis in ischemic stroke patients with nonvalvular atrial fibrillation.
      ].
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