title: Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders.
abstract: OBJECTIVE
  Carotid bifurcation angioplasty and stenting (CBAS) has generated controversy and widely divergent opinions about its current therapeutic role. To resolve differences and establish a unified view of CBAS' present role, a consensus conference of 17 experts, world opinion leaders from five countries, was held on November 21, 1999.
  
  
  METHODS
  These 17 participants had previously answered 18 key questions on current CBAS issues. At the conference these 18 questions and participants' answers were discussed and in some cases modified to determine points of agreement (consensus), near consensus, (prevailing opinion), or divided opinion (disagreement).
  
  
  RESULTS
  Conference discussion added two modified questions, placing a total of 20 key questions before the participants, representing four specialties (interventional radiology, seven; vascular surgery, six; interventional cardiology, three; neurosurgery, one). It is interesting that consensus was reached on the answers to 11 (55%) of 20 of the questions, and near consensus was reached on answers to 6 (30%) of 20 of the questions. Only with the answers to three (15%) of the questions was there persisting controversy. Moreover, both these differences and areas of agreement crossed specialty lines. Consensus Conclusions: CBAS should not currently undergo widespread practice, which should await results of randomized trials. CBAS is currently appropriate treatment for patients at high risk in experienced centers. CBAS is not generally appropriate for patients at low risk. Neurorescue skills should be available if CBAS is performed. When cerebral protection devices are available, they should be used for CBAS. Adequate stents and technology for performing CBAS currently exist. There were divergent opinions regarding the proportions of patients presently acceptable for CBAS treatment (<5% to 100%, mean 44%) and best treated by CBAS (<3% to 100%, mean 34%). These and other consensus conclusions will help physicians in all specialties deal with CBAS in a rational way rather than by being guided by unsubstantiated claims.
authors.affiliation: Division of Vascular Surgery, Montefiore Medical Center-Albert Einstein College of Medicine, New York, New York, USA.
authors.forename: F J
authors.initials: FJ
authors.lastname: Veith
authors.forename: M
authors.initials: M
authors.lastname: Amor
authors.forename: T
authors.initials: T
authors.lastname: Ohki
authors.forename: H G
authors.initials: HG
authors.lastname: Beebe
authors.forename: P R
authors.initials: PR
authors.lastname: Bell
authors.forename: A
authors.initials: A
authors.lastname: Bolia
authors.forename: P
authors.initials: P
authors.lastname: Bergeron
authors.forename: J J
authors.initials: JJ
authors.lastname: Connors
authors.forename: E B
authors.initials: EB
authors.lastname: Diethrich
authors.forename: R D
authors.initials: RD
authors.lastname: Ferguson
authors.forename: M
authors.initials: M
authors.lastname: Henry
authors.forename: R W
authors.initials: RW
authors.lastname: Hobson
authors.forename: L N
authors.initials: LN
authors.lastname: Hopkins
authors.forename: B T
authors.initials: BT
authors.lastname: Katzen
authors.forename: K
authors.initials: K
authors.lastname: Matthias
authors.forename: G S
authors.initials: GS
authors.lastname: Roubin
authors.forename: J
authors.initials: J
authors.lastname: Theron
authors.forename: M H
authors.initials: MH
authors.lastname: Wholey
authors.forename: S S
authors.initials: SS
authors.lastname: Yadav
mesh_terms: D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D001291:Attitude of Health Personnel; D019985:Benchmarking; D002340:Carotid Artery Diseases / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D004059:Diffusion of Innovation; D019317:Evidence-Based Medicine; D006801:Humans; D020380:Needs Assessment; D018579:Patient Selection; D017410:Practice Guidelines as Topic / Q000592:standards*; D012106:Research; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome