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. 2022 Aug;63(4):471-491.
doi: 10.23736/S0021-9509.22.12368-2.

Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine

Gaetano Lanza  1 , Massimiliano Orso  2 , Giuseppe Alba  3 , Sergio Bevilacqua  4 , Laura Capoccia  5 , Alessandro Cappelli  3 , Giampaolo Carrafiello  6 , Carlo Cernetti  7   8 , Marina Diomedi  9 , Walter Dorigo  10 , Gianluca Faggioli  11 , Vanni Giannace  3 , David Giannandrea  12 , Matteo Giannetta  13 , Jessica Lanza  14 , Gianfranco Lessiani  15 , Enrico M Marone  16 , Daniela Mazzaccaro  13 , Rino Migliacci  17 , Giovanni Nano  13 , Gabriele Pagliariccio  18 , Marco Petruzzellis  19 , Andrea Plutino  20 , Sara Pomatto  21 , Raffaele Pulli  22 , Nicoletta Reale  23 , Paola Santalucia  23 , Pasqualino Sirignano  5 , Giulia Ticozzelli  24 , Andrea Vacirca  25 , Emanuele Visco  7
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Free article

Guideline on carotid surgery for stroke prevention: updates from the Italian Society of Vascular and Endovascular Surgery. A trend towards personalized medicine

Gaetano Lanza et al. J Cardiovasc Surg (Torino). 2022 Aug.
Free article

Abstract

Background: This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association.

Methods: GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations.

Results: The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]).

Conclusions: This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice.

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