Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

Kosmas I Paraskevas¹, Dimitri P Mikhailidis², Pier Luigi Antignani³, Enrico Ascher⁴, Hediyeh Baradaran⁵, Reinoud P H Bokkers⁶, Richard P Cambria⁷, Anthony J Comerota⁸, Alan Dardik⁹, Alun H Davies¹⁰, Hans-Henning Eckstein¹¹, Gianluca Faggioli¹², Jose Fernandes E Fernandes¹³, Gustav Fraedrich¹⁴, George Geroulakos¹⁵, Peter Gloviczki¹⁶, Jonathan Golledge¹⁷, Ajay Gupta¹⁸, Mateja K Jezovnik¹⁹, Stavros K Kakkos²⁰, Niki Katsiki²¹, Michael Knoflach²², M Eline Kooi^{23

24}, Gaetano Lanza²⁵, George S Lavenson Jr²⁶, Christos D Liapis²⁷, Ian M Loftus²⁸, Armando Mansilha^{29

30}, Antoine Millon³¹, Andrew N Nicolaides³², Rodolfo Pini¹², Pavel Poredos³³, Robert M Proczka³⁴, Jean-Baptiste Ricco³⁵, Thomas S Riles³⁶, Peter Arthur Ringleb³⁷, Tatjana Rundek³⁸, Luca Saba³⁹, Felix Schlachetzki⁴⁰, Mauro Silvestrini⁴¹, Francesco Spinelli⁴², Francesco Stilo⁴², Sherif Sultan⁴³, Jasjit S Suri⁴⁴, Alexei V Svetlikov⁴⁵, Clark J Zeebregts⁴⁶, Seemant Chaturvedi⁴⁷

Affiliations

¹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
² Department of Clinical Biochemistry, 158987Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
³ Vascular Centre, Nuova Villa Claudia, Rome, Italy.
⁴ Division of Vascular Surgery, 12297Vascular Institute of New York, Brooklyn, NY, USA.
⁵ Department of Radiology, 14434University of Utah, Salt Lake City, UT, USA.
⁶ Department of Radiology, Medical Imaging Center, 10173University Medical Center Groningen, Groningen, The Netherlands.
⁷ Division of Vascular and Endovascular Surgery, St Elizabeth's Medical Center, Boston, MA, USA.
⁸ Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, VA, USA.
⁹ Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
¹⁰ Section of Vascular Surgery, 4615Imperial College and Imperial Healthcare NHS Trust, London, UK.
¹¹ Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
¹² Vascular Surgery, 9296University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
¹³ Department of Vascular Surgery, 37809University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal.
¹⁴ Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
¹⁵ Department of Vascular Surgery, 69038"Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁶ Division of Vascular and Endovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA.
¹⁷ Queensland Research Centre for Peripheral Vascular Disease, 8001James Cook University and Townsville University Hospital, Townsville, Queensland, Australia.
¹⁸ Department of Radiology, 466371Weill Cornell Medicine, New York, NY, USA.
¹⁹ Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, U.S.A.
²⁰ Department of Vascular Surgery, 37795University of Patras Medical School, Patras, Greece.
²¹ First Department of Internal Medicine, 37782AHEPA University Hospital, Thessaloniki, Greece.
²² Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria.
²³ CARIM School for Cardiovascular Disease, 5211Maastricht University, Maaastricht, The Netherlands.
²⁴ Department of Radiology and Nuclear Medicine, 5211Maastricht University Medical Center, Maastricht, The Netherlands.
²⁵ Vascular Surgery Department, 46837IRCSS MultiMedica Hospital, Castellanza, Italy.
²⁶ Department of Surgery, 1685Uniformed Services University, Bethesda, MD, USA.
²⁷ Athens Vascular Research Center, Athens, Greece.
²⁸ St George's Vascular Institute, St George's University London, London, UK.
²⁹ Faculty of Medicine of the University of Porto, Porto, Portugal.
³⁰ Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal.
³¹ Department of Vascular and Endovascular Surgery, 26899Louis Pradel Hospital, Hospices Civils de Lyon, France.
³² Department of Surgery, 121343University of Nicosia Medical School, Nicosia, Cyprus.
³³ Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia.
³⁴ 1stDepartment of Vascular Surgery, Medicover Hospital, Warsaw, Poland.
³⁵ Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France.
³⁶ Department of Surgery, Division of Vascular Surgery, 12297New York University Langone Medical Centre, New York, NY, USA.
³⁷ Department of Neurology, 546729University Hospital Heidelberg, Germany.
³⁸ Department of Neurology, Miller School of Medicine, 12235University of Miami, Miami, FL, USA.
³⁹ Department of Radiology, 97863Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy.
⁴⁰ Department of Neurology, 210419University of Regensburg, Regensburg, Germany.
⁴¹ Neurological Clinic, Department of Experimental and Clinical Medicine, 9294Marche Polytechnic University, Ancona, Italy.
⁴² Vascular Surgery Division, 9311Campus Bio-Medico University of Rome, Rome, Italy.
⁴³ Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.
⁴⁴ Stroke Diagnosis and Monitoring Division, AtheroPointTM, Roseville, USA.
⁴⁵ Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburgh, Russia.
⁴⁶ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴⁷ Department of Neurology & Stroke Program, 12264University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 35412377
DOI: 10.1177/00033197221081914

Review

Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

Kosmas I Paraskevas et al. Angiology. 2022 Nov-Dec.

. 2022 Nov-Dec;73(10):903-910.

doi: 10.1177/00033197221081914. Epub 2022 Apr 12.

Authors

Affiliations

¹ Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
² Department of Clinical Biochemistry, 158987Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK.
³ Vascular Centre, Nuova Villa Claudia, Rome, Italy.
⁴ Division of Vascular Surgery, 12297Vascular Institute of New York, Brooklyn, NY, USA.
⁵ Department of Radiology, 14434University of Utah, Salt Lake City, UT, USA.
⁶ Department of Radiology, Medical Imaging Center, 10173University Medical Center Groningen, Groningen, The Netherlands.
⁷ Division of Vascular and Endovascular Surgery, St Elizabeth's Medical Center, Boston, MA, USA.
⁸ Inova Heart and Vascular Institute, Inova Alexandria Hospital, Alexandria, VA, USA.
⁹ Division of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT, USA.
¹⁰ Section of Vascular Surgery, 4615Imperial College and Imperial Healthcare NHS Trust, London, UK.
¹¹ Department for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
¹² Vascular Surgery, 9296University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
¹³ Department of Vascular Surgery, 37809University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal.
¹⁴ Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
¹⁵ Department of Vascular Surgery, 69038"Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
¹⁶ Division of Vascular and Endovascular Surgery, 6915Mayo Clinic, Rochester, MN, USA.
¹⁷ Queensland Research Centre for Peripheral Vascular Disease, 8001James Cook University and Townsville University Hospital, Townsville, Queensland, Australia.
¹⁸ Department of Radiology, 466371Weill Cornell Medicine, New York, NY, USA.
¹⁹ Department of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX, U.S.A.
²⁰ Department of Vascular Surgery, 37795University of Patras Medical School, Patras, Greece.
²¹ First Department of Internal Medicine, 37782AHEPA University Hospital, Thessaloniki, Greece.
²² Department of Neurology, 27280Medical University of Innsbruck, Innsbruck, Austria.
²³ CARIM School for Cardiovascular Disease, 5211Maastricht University, Maaastricht, The Netherlands.
²⁴ Department of Radiology and Nuclear Medicine, 5211Maastricht University Medical Center, Maastricht, The Netherlands.
²⁵ Vascular Surgery Department, 46837IRCSS MultiMedica Hospital, Castellanza, Italy.
²⁶ Department of Surgery, 1685Uniformed Services University, Bethesda, MD, USA.
²⁷ Athens Vascular Research Center, Athens, Greece.
²⁸ St George's Vascular Institute, St George's University London, London, UK.
²⁹ Faculty of Medicine of the University of Porto, Porto, Portugal.
³⁰ Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal.
³¹ Department of Vascular and Endovascular Surgery, 26899Louis Pradel Hospital, Hospices Civils de Lyon, France.
³² Department of Surgery, 121343University of Nicosia Medical School, Nicosia, Cyprus.
³³ Department of Vascular Disease, University Medical Centre Ljubljana, Slovenia.
³⁴ 1stDepartment of Vascular Surgery, Medicover Hospital, Warsaw, Poland.
³⁵ Department of Clinical Research, University of Poitiers, CHU de Poitiers, Poitiers, France.
³⁶ Department of Surgery, Division of Vascular Surgery, 12297New York University Langone Medical Centre, New York, NY, USA.
³⁷ Department of Neurology, 546729University Hospital Heidelberg, Germany.
³⁸ Department of Neurology, Miller School of Medicine, 12235University of Miami, Miami, FL, USA.
³⁹ Department of Radiology, 97863Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy.
⁴⁰ Department of Neurology, 210419University of Regensburg, Regensburg, Germany.
⁴¹ Neurological Clinic, Department of Experimental and Clinical Medicine, 9294Marche Polytechnic University, Ancona, Italy.
⁴² Vascular Surgery Division, 9311Campus Bio-Medico University of Rome, Rome, Italy.
⁴³ Western Vascular Institute, Department of Vascular and Endovascular Surgery, University Hospital Galway, National University of Ireland, Galway, Ireland.
⁴⁴ Stroke Diagnosis and Monitoring Division, AtheroPointTM, Roseville, USA.
⁴⁵ Division of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburgh, Russia.
⁴⁶ Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
⁴⁷ Department of Neurology & Stroke Program, 12264University of Maryland School of Medicine, Baltimore, MD, USA.

PMID: 35412377
DOI: 10.1177/00033197221081914

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.

Keywords: asymptomatic carotid stenosis; best medical treatment; carotid artery stenting; carotid endarterectomy; guidelines; stroke.

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Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

Affiliations

Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

Authors

Affiliations

Abstract

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LinkOut - more resources

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Medical