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

Author:

Paraskevas Kosmas I.1ORCID,Mikhailidis Dimitri P.2,Antignani Pier Luigi3,Ascher Enrico4,Baradaran Hediyeh5,Bokkers Reinoud P.H.6,Cambria Richard P.7,Comerota Anthony J.8,Dardik Alan9,Davies Alun H.10,Eckstein Hans-Henning11,Faggioli Gianluca12,Fernandes e Fernandes Jose13,Fraedrich Gustav14,Geroulakos George15,Gloviczki Peter16,Golledge Jonathan17,Gupta Ajay18,Jezovnik Mateja K.19ORCID,Kakkos Stavros K.20,Katsiki Niki21ORCID,Knoflach Michael22,Eline Kooi M.2324,Lanza Gaetano25,Lavenson George S.26,Liapis Christos D.27,Loftus Ian M.28,Mansilha Armando2930,Millon Antoine31,Nicolaides Andrew N.32,Pini Rodolfo12ORCID,Poredos Pavel33ORCID,Proczka Robert M.34,Ricco Jean-Baptiste35,Riles Thomas S.36,Ringleb Peter Arthur37,Rundek Tatjana38,Saba Luca39,Schlachetzki Felix40,Silvestrini Mauro41,Spinelli Francesco42,Stilo Francesco42,Sultan Sherif43,Suri Jasjit S.44,Svetlikov Alexei V.45ORCID,Zeebregts Clark J.46,Chaturvedi Seemant47

Affiliation:

1. Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece

2. Department of Clinical Biochemistry, Royal 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, Vascular Institute of New York, Brooklyn, NY, USA

5. Department of Radiology, University of Utah, Salt Lake City, UT, USA

6. Department of Radiology, Medical Imaging Center, University 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, Imperial 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, University of Bologna “Alma Mater Studiorum”, Policlinico S. Orsola Malpighi, Bologna, Italy

13. Department of Vascular Surgery, University of Lisbon, Lisbon Academic Medical Center, Lisbon, Portugal

14. Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria

15. Department of Vascular Surgery, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece

16. Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA

17. Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Townsville, Queensland, Australia

18. Department of Radiology, Weill 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, University of Patras Medical School, Patras, Greece

21. First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece

22. Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

23. CARIM School for Cardiovascular Disease, Maastricht University, Maaastricht, The Netherlands

24. Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands

25. Vascular Surgery Department, IRCSS MultiMedica Hospital, Castellanza, Italy

26. Department of Surgery, Uniformed 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, Louis Pradel Hospital, Hospices Civils de Lyon, France

32. Department of Surgery, University 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, New York University Langone Medical Centre, New York, NY, USA

37. Department of Neurology, University Hospital Heidelberg, Germany

38. Department of Neurology, Miller School of Medicine, University of Miami, Miami, FL, USA

39. Department of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy

40. Department of Neurology, University of Regensburg, Regensburg, Germany

41. Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy

42. Vascular Surgery Division, Campus 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, University of Maryland School of Medicine, Baltimore, MD, USA

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.

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine

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