Carotid atherosclerotic disease continues to be an important cause of
stroke, often disabling or fatal. Such
strokes could be largely prevented through optimal medical
therapy and carotid revascularization. Advancements in discovery research and imaging along with evidence from recent pharmacology and interventional clinical trials and registries and the progress in
acute stroke management have markedly expanded knowledge base for clinical decisions in
carotid stenosis. Nevertheless, there is variability in carotid-related
stroke prevention and management strategies across medical specialities. Optimal patient care can be achieved by (1) establishing a unified knowledge foundation and (2) fostering multi-specialty collaborative guidelines. The emergent Neuro-Vascular Team concept, mirroring the multi-disciplinary Heart Team, embraces diverse specializations, tailores personalized, stratified medicine approaches to individual patient needs, and integrates innovative imaging and risk-assessment
biomarkers. Proposed approach integrates collaboration of multiple specialists central to
carotid artery stenosis management such as neurology,
stroke medicine, cardiology, angiology, ophthalmology,
vascular surgery, endovascular interventions, neuroradiology and neurosurgery. Moreover, patient education regarding current treatment options, their risks and advantages, is pivotal, promting patient's active role in clinical care decisions. This enables optimization of interventions ranging from lifestyle modification, carotid revascularization by stenting or
endarterectomy, as well as pharmacological management encompassing
statins, novel
lipid-lowering and antithrombotic strategies and targeting
inflammation and vascular dysfunction. This consensus document provides a harmonized multi-specialty approach to multimorbidity prevention in
carotid stenosis patients, based on comprehensive knowledge review, pinpointing research gaps in an evidence-based medicine approach. It aims to be a foundational tool for interdisciplinary collaboration and prioritized patient-centric decision-making.