Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis (2023)

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.

Original languageEnglish
Pages (from-to)903-910
Number of pages8
JournalAngiology
Volume73
Issue number10
Early online date12-Apr-2022
DOIs
Publication statusPublished - Nov-2022

Keywords

  • asymptomatic carotid stenosis
  • best medical treatment
  • stroke
  • carotid endarterectomy
  • carotid artery stenting
  • guidelines
  • TRANSCAROTID ARTERY REVASCULARIZATION
  • VASCULAR-SURGERY GUIDELINES
  • SMOKING-CESSATION RATES
  • EUROPEAN-SOCIETY
  • FOLLOW-UP
  • ENDARTERECTOMY
  • DIAGNOSIS

Access to Document

  • Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid StenosisFinal publisher's version, 512 KBLicence: Taverne

    Cite this

    • APA
    • Author
    • BIBTEX
    • Harvard
    • Standard
    • RIS
    • Vancouver

    Paraskevas, K. I., Mikhailidis, D. P., Antignani, P. L., Ascher, E., Baradaran, H., Bokkers, R. P. H., Cambria, R. P., Comerota, A. J., Dardik, A., Davies, A. H., Eckstein, H-H., Faggioli, G., Fernandes E Fernandes, J., Fraedrich, G., Geroulakos, G., Gloviczki, P., Golledge, J., Gupta, A., Jezovnik, M. K., ... Chaturvedi, S. (2022). Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis. Angiology, 73(10), 903-910. https://doi.org/10.1177/00033197221081914

    Paraskevas, Kosmas I ; Mikhailidis, Dimitri P ; Antignani, Pier Luigi ; Ascher, Enrico ; Baradaran, Hediyeh ; Bokkers, Reinoud P H ; Cambria, Richard P ; Comerota, Anthony J ; Dardik, Alan ; Davies, Alun H ; Eckstein, Hans-Henning ; Faggioli, Gianluca ; Fernandes E Fernandes, Jose ; Fraedrich, Gustav ; Geroulakos, George ; Gloviczki, Peter ; Golledge, Jonathan ; Gupta, Ajay ; Jezovnik, Mateja K ; Kakkos, Stavros K ; Katsiki, Niki ; Knoflach, Michael ; Eline Kooi, M ; Lanza, Gaetano ; Lavenson, George S ; Liapis, Christos D ; Loftus, Ian M ; Mansilha, Armando ; Millon, Antoine ; Nicolaides, Andrew N ; Pini, Rodolfo ; Poredos, Pavel ; Proczka, Robert M ; Ricco, Jean-Baptiste ; Riles, Thomas S ; Ringleb, Peter Arthur ; Rundek, Tatjana ; Saba, Luca ; Schlachetzki, Felix ; Silvestrini, Mauro ; Spinelli, Francesco ; Stilo, Francesco ; Sultan, Sherif ; Suri, Jasjit S ; Svetlikov, Alexei V ; Zeebregts, Clark J ; Chaturvedi, Seemant. / Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis. In: Angiology. 2022 ; Vol. 73, No. 10. pp. 903-910.

    @article{d2996c5c79e747fc8a63f1da5a3886e3,

    (Video) Workshop 1 Carotid stenosis but asymptomatic: operate or stent and when?

    title = "Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis",

    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, stroke, carotid endarterectomy, carotid artery stenting, guidelines, TRANSCAROTID ARTERY REVASCULARIZATION, VASCULAR-SURGERY GUIDELINES, SMOKING-CESSATION RATES, EUROPEAN-SOCIETY, FOLLOW-UP, ENDARTERECTOMY, DIAGNOSIS",

    author = "Paraskevas, {Kosmas I} and Mikhailidis, {Dimitri P} and Antignani, {Pier Luigi} and Enrico Ascher and Hediyeh Baradaran and Bokkers, {Reinoud P H} and Cambria, {Richard P} and Comerota, {Anthony J} and Alan Dardik and Davies, {Alun H} and Hans-Henning Eckstein and Gianluca Faggioli and {Fernandes E Fernandes}, Jose and Gustav Fraedrich and George Geroulakos and Peter Gloviczki and Jonathan Golledge and Ajay Gupta and Jezovnik, {Mateja K} and Kakkos, {Stavros K} and Niki Katsiki and Michael Knoflach and {Eline Kooi}, M and Gaetano Lanza and Lavenson, {George S} and Liapis, {Christos D} and Loftus, {Ian M} and Armando Mansilha and Antoine Millon and Nicolaides, {Andrew N} and Rodolfo Pini and Pavel Poredos and Proczka, {Robert M} and Jean-Baptiste Ricco and Riles, {Thomas S} and Ringleb, {Peter Arthur} and Tatjana Rundek and Luca Saba and Felix Schlachetzki and Mauro Silvestrini and Francesco Spinelli and Francesco Stilo and Sherif Sultan and Suri, {Jasjit S} and Svetlikov, {Alexei V} and Zeebregts, {Clark J} and Seemant Chaturvedi",

    year = "2022",

    month = nov,

    doi = "10.1177/00033197221081914",

    language = "English",

    volume = "73",

    pages = "903--910",

    journal = "Angiology",

    issn = "0003-3197",

    publisher = "SAGE Publications Inc.",

    number = "10",

    }

    Paraskevas, KI, Mikhailidis, DP, Antignani, PL, Ascher, E, Baradaran, H, Bokkers, RPH, Cambria, RP, Comerota, AJ, Dardik, A, Davies, AH, Eckstein, H-H, Faggioli, G, Fernandes E Fernandes, J, Fraedrich, G, Geroulakos, G, Gloviczki, P, Golledge, J, Gupta, A, Jezovnik, MK, Kakkos, SK, Katsiki, N, Knoflach, M, Eline Kooi, M, Lanza, G, Lavenson, GS, Liapis, CD, Loftus, IM, Mansilha, A, Millon, A, Nicolaides, AN, Pini, R, Poredos, P, Proczka, RM, Ricco, J-B, Riles, TS, Ringleb, PA, Rundek, T, Saba, L, Schlachetzki, F, Silvestrini, M, Spinelli, F, Stilo, F, Sultan, S, Suri, JS, Svetlikov, AV, Zeebregts, CJ & Chaturvedi, S 2022, 'Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis', Angiology, vol. 73, no. 10, pp. 903-910. https://doi.org/10.1177/00033197221081914

    Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis. / Paraskevas, Kosmas I; Mikhailidis, Dimitri P; Antignani, Pier Luigi; Ascher, Enrico; Baradaran, Hediyeh; Bokkers, Reinoud P H; Cambria, Richard P; Comerota, Anthony J; Dardik, Alan; Davies, Alun H; Eckstein, Hans-Henning; Faggioli, Gianluca; Fernandes E Fernandes, Jose; Fraedrich, Gustav; Geroulakos, George; Gloviczki, Peter; Golledge, Jonathan; Gupta, Ajay; Jezovnik, Mateja K; Kakkos, Stavros K; Katsiki, Niki; Knoflach, Michael; Eline Kooi, M; Lanza, Gaetano; Lavenson, George S; Liapis, Christos D; Loftus, Ian M; Mansilha, Armando; Millon, Antoine; Nicolaides, Andrew N; Pini, Rodolfo; Poredos, Pavel; Proczka, Robert M; Ricco, Jean-Baptiste; Riles, Thomas S; Ringleb, Peter Arthur; Rundek, Tatjana; Saba, Luca; Schlachetzki, Felix; Silvestrini, Mauro; Spinelli, Francesco; Stilo, Francesco; Sultan, Sherif; Suri, Jasjit S; Svetlikov, Alexei V; Zeebregts, Clark J; Chaturvedi, Seemant.

    In: Angiology, Vol. 73, No. 10, 11.2022, p. 903-910.

    Research output: Contribution to journalReview articleAcademicpeer-review

    TY - JOUR

    T1 - Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

    (Video) Endarterectomy and Stenting for Carotid Artery Stenosis

    AU - Paraskevas, Kosmas I

    AU - Mikhailidis, Dimitri P

    AU - Antignani, Pier Luigi

    AU - Ascher, Enrico

    AU - Baradaran, Hediyeh

    AU - Bokkers, Reinoud P H

    AU - Cambria, Richard P

    AU - Comerota, Anthony J

    AU - Dardik, Alan

    AU - Davies, Alun H

    AU - Eckstein, Hans-Henning

    AU - Faggioli, Gianluca

    AU - Fernandes E Fernandes, Jose

    AU - Fraedrich, Gustav

    AU - Geroulakos, George

    AU - Gloviczki, Peter

    AU - Golledge, Jonathan

    AU - Gupta, Ajay

    AU - Jezovnik, Mateja K

    AU - Kakkos, Stavros K

    AU - Katsiki, Niki

    AU - Knoflach, Michael

    AU - Eline Kooi, M

    AU - Lanza, Gaetano

    AU - Lavenson, George S

    AU - Liapis, Christos D

    (Video) Why and When we need treatment for Asymptomatic Carotid Stenosis, New guidelines

    AU - Loftus, Ian M

    AU - Mansilha, Armando

    AU - Millon, Antoine

    AU - Nicolaides, Andrew N

    AU - Pini, Rodolfo

    AU - Poredos, Pavel

    AU - Proczka, Robert M

    AU - Ricco, Jean-Baptiste

    AU - Riles, Thomas S

    AU - Ringleb, Peter Arthur

    AU - Rundek, Tatjana

    AU - Saba, Luca

    AU - Schlachetzki, Felix

    AU - Silvestrini, Mauro

    AU - Spinelli, Francesco

    AU - Stilo, Francesco

    AU - Sultan, Sherif

    AU - Suri, Jasjit S

    AU - Svetlikov, Alexei V

    AU - Zeebregts, Clark J

    AU - Chaturvedi, Seemant

    PY - 2022/11

    Y1 - 2022/11

    N2 - 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.

    AB - 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.

    KW - asymptomatic carotid stenosis

    (Video) NSI Webinar - Management of Carotid Stenosis || 8th October 2022 ||

    KW - best medical treatment

    KW - stroke

    KW - carotid endarterectomy

    KW - carotid artery stenting

    KW - guidelines

    KW - TRANSCAROTID ARTERY REVASCULARIZATION

    KW - VASCULAR-SURGERY GUIDELINES

    KW - SMOKING-CESSATION RATES

    KW - EUROPEAN-SOCIETY

    KW - FOLLOW-UP

    KW - ENDARTERECTOMY

    KW - DIAGNOSIS

    U2 - 10.1177/00033197221081914

    DO - 10.1177/00033197221081914

    M3 - Review article

    C2 - 35412377

    VL - 73

    SP - 903

    EP - 910

    JO - Angiology

    JF - Angiology

    SN - 0003-3197

    IS - 10

    ER -

    Paraskevas KI, Mikhailidis DP, Antignani PL, Ascher E, Baradaran H, Bokkers RPH et al. Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis. Angiology. 2022 Nov;73(10):903-910. https://doi.org/10.1177/00033197221081914

    (Video) Cognitive Decline with Asymptomatic Carotid Stenosis

    Videos

    1. Management of Asymptomatic Carotid Artery Disease
    (Icahn School of Medicine)
    2. Update on SVS Clinical Practice Guidelines of Extracranial Carotid Vascular Disease
    (Stanford Surgery)
    3. Carotid disease management - symptomatic and asymptomatic
    (BSET)
    4. CME: Management of Severe Carotid Stenosis | Paul Armstrong, DO
    (AdventHealth Tampa)
    5. JB. Ricco Lecture: management of symptomatic stenosis
    (European Society of Cardiology)
    6. CPC: A Case of Asymptomatic Carotid Stenosis in a Hypertensive Patient
    (AHAScienceNews)
    Top Articles
    Latest Posts
    Article information

    Author: Barbera Armstrong

    Last Updated: 01/18/2023

    Views: 6009

    Rating: 4.9 / 5 (59 voted)

    Reviews: 82% of readers found this page helpful

    Author information

    Name: Barbera Armstrong

    Birthday: 1992-09-12

    Address: Suite 993 99852 Daugherty Causeway, Ritchiehaven, VT 49630

    Phone: +5026838435397

    Job: National Engineer

    Hobby: Listening to music, Board games, Photography, Ice skating, LARPing, Kite flying, Rugby

    Introduction: My name is Barbera Armstrong, I am a lovely, delightful, cooperative, funny, enchanting, vivacious, tender person who loves writing and wants to share my knowledge and understanding with you.