Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis
Year: 2022
Type: article
Abstract: Despite the publication of several national/international guidelines, the optimal management of patients with asymptomatic carotid stenosis (AsxCS) remains controversial. This article compares 3 recently released guidelines (the 2020 German-Austrian, the 2021 European Stroke Organization [ESO], and the 2021 Society for Vascular Surgery [SVS] guidelines) vs the 2017 European Society for Vascular Surgery (ESVS) guidelines regarding the optimal management of AsxCS patients.The 2017 ESVS guidelines defined specific imaging/clinical parameters that may identify patient subgroups at high future stroke risk and recommended that carotid endarterectomy (CEA) should or carotid artery stenting (CAS) may be considered for these individuals. The 2020 German-Austrian guidelines provided similar recommendations with the 2017 ESVS Guidelines. The 2021 ESO Guidelines also recommended CEA for AsxCS patients at high risk for stroke on best medical treatment (BMT), but recommended against routine use of CAS in these patients. Finally, the SVS guidelines provided a strong recommendation for CEA+BMT vs BMT alone for low-surgical risk patients with >70% AsxCS. Thus, the ESVS, German-Austrian, and ESO guidelines concurred that all AsxCS patients should receive risk factor modification and BMT, but CEA should or CAS may also be considered for certain AsxCS patient subgroups at high risk for future ipsilateral ischemic stroke.
Source: Angiology
Authors: Kosmas I. Paraskevas, Dimitri P. Mikhailidis, Pier Luigi Antignani, Enrico Ascher, Hediyeh Baradaran, Reinoud P.H. Bokkers, Richard P. Cambria, Anthony J. Comerota, Alan Dardik, Alun H. Davies, Hans-Henning Eckstein, Gianluca Faggioli, Jose Fernandes e Fernandes, Gustav Fraedrich, George Geroulakos, Peter Gloviczki, Jonathan Golledge, Ajay Gupta, Mateja K. Jezovnik, Stavros K. Kakkos, Niki Katsiki, Michael Knoflach, M. Eline Kooi, Gaetano Lanza, George S. Lavenson, Christos D. Liapis, Ian M. Loftus, Armando Mansilha, Antoine Millon, Andrew N. Nicolaides, Rodolfo Pini, Pavel Poredos, Robert M. Proczka, Jean-Baptiste Ricco, Thomas S. Riles, Peter Arthur Ringleb, Tatjana Rundek, Luca Saba, Felix Schlachetzki, Mauro Silvestrini, Francesco Spinelli, Francesco Stilo, Sherif Sultan, Jasjit S. Suri, Alexei V. Svetlikov, Clark J. Zeebregts, Seemant Chaturvedi
Institutions: The Royal Free Hospital, University College London, Vascular Institute of New York, University of Utah, University Medical Center Groningen, St. Elizabeth's Medical Center, Inova Alexandria Hospital, Yale University, Imperial College Healthcare NHS Trust, Imperial College London, TUM Klinikum, Technical University of Munich, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, University of Lisbon, Innsbruck Medical University, Universität Innsbruck, National and Kapodistrian University of Athens, University General Hospital Attikon, Mayo Clinic, Townsville Hospital, James Cook University, Weill Cornell Medicine, The University of Texas Health Science Center at Houston, University of Patras, AHEPA University Hospital, Maastricht University Medical Centre, Maastricht University, MultiMedica, Uniformed Services University of the Health Sciences, St George's, University of London, Universidade do Porto, Hospital de São João, Hospices Civils de Lyon, Hôpital Louis Pradel, University of Nicosia, Ljubljana University Medical Centre, Medicover, Université de Poitiers, Centre Hospitalier Universitaire de Poitiers, NYU Langone Health, New York University, University Hospital Heidelberg, University of Miami, Azienda Ospedaliero-Universitaria Cagliari, University of Regensburg, Marche Polytechnic University, Università Campus Bio-Medico, Ollscoil na Gaillimhe – University of Galway, University Hospital Galway, Federal Medical-Biological Agency, University of Groningen, University of Maryland, Baltimore
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4223434423