ESVS Guidelines. Invasive Treatment for Carotid Stenosis: Indications, Techniques

• Published in: European journal of vascular and endovascular surgery Vol. 37; no. 4; pp. 1 - 19
• Main Authors: Liapis, C.D, Bell, Sir P.R.F, Mikhailidis, D, Sivenius, J, Nicolaides, A, Fernandes e Fernandes, J, Biasi, G, Norgren, L
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2009
• Subjects: Angioplasty; Carotid stenosis; Carotid Stenosis - complications; Carotid Stenosis - therapy; Clinical Trials as Topic; Comorbidity; Coronary Artery Bypass; Coronary Artery Disease - surgery; Endarterectomy; Europe; Guidelines; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Ischemic Attack, Transient - etiology; Ischemic Attack, Transient - prevention & control; Kirurgi; Kirurgisk forskning; Kärlkirurgi; MEDICIN; MEDICINE; Myocardial Infarction - prevention & control; Patient Selection; Platelet Aggregation Inhibitors - therapeutic use; Societies, Medical; Stenting; Stents; Stroke - etiology; Stroke - prevention & control; Surgery; Surgical research; Treatment; Vascular surgery; Vascular Surgical Procedures; Europe; Carotid stenosis; Stenting; Treatment; Angioplasty; Endarterectomy; Guidelines
• DOI: 10.1016/j.ejvs.2008.11.006
• ISSN: 1078-5884; 1532-2165

Summary The European Society for Vascular Surgery brought together a group of experts in the field of carotid artery disease to produce updated guidelines for the invasive treatment of carotid disease. The recommendations were rated according to the level of evidence. Carotid endarterectomy (CEA) is recommended in symptomatic patients with >50% stenosis if the perioperative stroke/death rate is <6% [A], preferably within 2 weeks of the patient's last symptoms [A]. CEA is also recommended in asymptomatic men <75 years old with 70–99% stenosis if the perioperative stroke/death risk is <3% [A]. The benefit from CEA in asymptomatic women is significantly less than in men [A]. CEA should therefore be considered only in younger, fit women [A]. Carotid patch angioplasty is preferable to primary closure [A]. Aspirin at a dose of 75–325 mg daily and statins should be given before, during and following CEA. [A] Carotid artery stenting (CAS) should be performed only in high-risk for CEA patients, in high-volume centres with documented low peri-operative stroke and death rates or inside a randomized controlled trial [C]. CAS should be performed under dual antiplatelet treatment with aspirin and clopidogrel [A]. Carotid protection devices are probably of benefit [C].