BC 075 – Traitement médical ou par revascularisation dans la sténose carotidienne asymptomatique (étude CREST-2)

Dans cette 75e baladodiffusion, les Drs Alexandre Mutchmore et Luc Lanthier discutent du traitement de la sténose carotidienne asymptomatique, en plus de réviser la littérature médicale de décembre 2025.
 
Quiz clinique (3 min 30), présentation principale (4 min 32), critique (32 min 22), retour sur le cas clinique (41 min 51), autres articles (45 min 57), réponse au quiz clinique (49 min 26).
 
Référence principale :
 
Brott TG, Howard G, Lal BK, Voeks JH, Turan TN, Roubin GS, et al. Medical Management and Revascularization for Asymptomatic Carotid Stenosis. N Engl J Med. 2026;394(3):219-31. PubMed PMID: 41269206.
 
Articles associés : 
 
Brown MM, Bonati LH. Managing Asymptomatic Carotid Stenosis. N Engl J Med. 2026;394(3):296-97. PubMed PMID: 41269202.
 
North American Symptomatic Carotid Endarterectomy Trial Collaborators; Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, Fox AJ, Rankin RN, Hachinski VC, Wiebers DO, Eliasziw M. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445-53. PubMed PMID: 1852179.
 
Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998;351(9113):1379-87. PubMed PMID: 9593407.
 
Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. JAMA. 1995;273(18):1421-8. PubMed PMID: 7723155.
 
Halliday A, Mansfield A, Marro J, Peto C, Peto R, Potter J, Thomas D; MRC Asymptomatic Carotid Surgery Trial (ACST) Collaborative Group. Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial. Lancet. 2004;363(9420):1491-502. PubMed PMID: 15135594.
 
Naylor R, Rantner B, Ancetti S, de Borst GJ, De Carlo M, Halliday A, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2023;65(1):7-111. PubMed PMID: 35598721.
 
Bushnell C, Kernan WN, Sharrief AZ, Chaturvedi S, Cole JW, Cornwell WK, 3rd, et al. 2024 Guideline for the Primary Prevention of Stroke: A Guideline From the American Heart Association/American Stroke Association. Stroke. 2024;55(12):e344-e424. PubMed PMID: 39429201.
 
Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, et al; SPACE-2 Investigators. Carotid endarterectomy or stenting or best medical treatment alone for moderate-to-severe asymptomatic carotid artery stenosis: 5-year results of a multicentre, randomised controlled trial. Lancet Neurol. 2022;21(10):877-888. PubMed PMID: 36115360.
 
Howard DPJ, Gaziano L, Rothwell PM, Oxford Vascular S. Risk of stroke in relation to degree of asymptomatic carotid stenosis: a population-based cohort study, systematic review, and meta-analysis. Lancet Neurol. 2021;20(3):193-202. PubMed PMID: 33609477.
 
Donners SJA, van Velzen TJ, Cheng SF, Gregson J, Hazewinkel AD, Pizzini FB, et al. Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-intermediate risk symptomatic carotid stenosis (ECST-2): 2-year interim results of a multicentre randomised trial. Lancet Neurol. 2025;24(5):389-99. PubMed PMID: 40252662.
 
Autres articles d’intérêt récent : 
 
Nicholls SJ, Pavo I, Bhatt DL, Buse JB, Del Prato S, Kahn SE, et al. Cardiovascular Outcomes with Tirzepatide versus Dulaglutide in Type 2 Diabetes. N Engl J Med. 2025;393(24):2409-20. PubMed PMID: 41406444.
 
Kougias P, Sharath SE, Zhan M, Carson JL, Norman LE, Mi Z, et al. Liberal or Restrictive Postoperative Transfusion in Patients at High Cardiac Risk: The TOP Randomized Clinical Trial. JAMA. 2025;334(24):2197-207. PubMed PMID: 41205227.
 
Horn DB, Ryan DH, Kis SG, Alves B, Mu Y, Kim SG, et al. Orforglipron, an oral small-molecule GLP-1 receptor agonist, for the treatment of obesity in people with type 2 diabetes (ATTAIN-2): a phase 3, double-blind, randomised, multicentre, placebo-controlled trial. Lancet. 2026;406(10522):2927-44. PubMed PMID: 41275875.
 
Xie M, Eyting M, Bommer C, Ahmed H, Geldsetzer P. The effect of shingles vaccination at different stages of the dementia disease course. Cell. 2025;188(25):7049-64 e20. PubMed PMID: 41338191.
 
Guides de pratique : 
 
Tan DHS, Hull MW, Onyegbule SO, Ajiboye W, Arkell C, Baril JG, et al. Canadian guideline on HIV pre- and postexposure prophylaxis: 2025 update. CMAJ. 2025;197(41):E1374-E91. PubMed PMID: 41326046.
 
Scott FI, Ananthakrishnan AN, Click B, Agrawal M, Syal G, Haydek JP, et al. AGA Living Clinical Practice Guideline on the Pharmacologic Management of Moderate-to-Severe Crohn’s Disease. Gastroenterology. 2025;169(7):1397-448. PubMed PMID: 41274746.
 
Orman ES, Fortune BE, John BV, Asrani SK. AGA Clinical Practice Update on the Management of Ascites, Volume Overload, and Hyponatremia in Cirrhosis: Expert Review. Gastroenterology. 2025;169(7):1547-57. PubMed PMID: 41114681.
 
Référence du quiz clinique :
 
Rajkumar SV, Kumar S. Monoclonal Gammopathy of Undetermined Significance. N Engl J Med. 2025 Oct 2;393(13):1315-1326. PubMed PMID: 41032708.