Management of atherosclerotic carotid artery disease: clinical practice guidelines of the Society for Vascular Surgery.
The Society for Vascular Surgery (SVS) appointed a committee of experts to formulate evidence-based clinical guidelines for the management of carotid stenosis. In formulating clinical practice recommendations, the committee used systematic reviews to summarize the best available evidence and the GRADE scheme to grade the strength of recommendations (GRADE 1 for strong recommendations; GRADE 2 for weak recommendations) and rate the quality of evidence (high, moderate, low, and very low quality). In symptomatic and asymptomatic patients with low-grade carotid stenosis (<50% in symptomatic and <60% in asymptomatic patients), we recommend optimal medical therapy rather than revascularization (GRADE 1 recommendation, high quality evidence). In symptomatic patients with moderate to severe carotid stenosis (more than 50%), we recommend carotid endarterectomy plus optimal medical therapy (GRADE 1 recommendation, high quality evidence). In symptomatic patients with moderate to severe carotid stenosis (>/=50%) and high perioperative risk, we suggest carotid artery stenting as a potential alternative to carotid endarterectomy (GRADE 2 recommendation, low quality evidence). In asymptomatic patients with moderate to severe carotid stenosis (>/=60%), we recommend carotid endarterectomy plus medical management as long as the perioperative risk is low (GRADE 1 recommendation, high quality evidence). We recommend against carotid artery stenting for asymptomatic patients with moderate to severe (>/=60%) carotid artery stenosis (GRADE 1 recommendation, low quality evidence). A possible exception includes patients with >/=80% carotid artery stenosis and high anatomic risk for carotid endarterectomy.
Hobson
Robert W
RW
University of Medicine and Dentistry of New Jersey, Newark, NJ, USA.
Mackey
William C
WC
Ascher
Enrico
E
Murad
M Hassan
MH
Calligaro
Keith D
KD
Comerota
Anthony J
AJ
Montori
Victor M
VM
Eskandari
Mark K
MK
Massop
Douglas W
DW
Bush
Ruth L
RL
Lal
Brajesh K
BK
Perler
Bruce A
BA
D000792:Angiography / Q000379:methods; D017130:Angioplasty / Q000379:methods; D050197:Atherosclerosis / Q000150:complications* / Q000401:mortality / Q000628:therapy*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000379:methods; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018579:Patient Selection; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012720:Severity of Illness Index; D012955:Societies, Medical; D015607:Stents; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014481:United States
D010975:Platelet Aggregation Inhibitors