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

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

@article{d2996c5c79e747fc8a63f1da5a3886e3,

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",

}

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 journal › Review article › Academic › peer-review

TY - JOUR

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

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

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