title: The role of endarterectomy and stenting in the management of carotid artery stenosis: a 5-year Delphi survey.
abstract: BACKGROUND
  Ambiguity in the literature concerning potential benefits of carotid artery stenting (CAS) as an alternative to carotid endarterectomy (CEA) necessitated a 5-year Delphi-type survey, gauging the changing views over this period of relevant experts undertaking carotid intervention.
  
  
  METHODS
  Delphi surveys performed in 2004 and 2009 involved 2 rounds of questions combined with feedback of results from the first round between them. The questionnaire was e-mailed to UK vascular surgeons, neurosurgeons, interventional radiologists, and cardiologists.
  
  
  RESULTS
  In 2004 and 2009, the second round response rates were 69% and 51%, respectively. Over 5 years, there was a statistically significant reduction in support for ''general anesthesia risk'' and ''contralateral occlusion'' as indications for CAS and views that CAS ''increased patient satisfaction'' and ''decreased the length of hospital stay.'' Concerning the impact of recent trials on the professionals' treatment routines for symptomatic and asymptomatic patients with carotid disease, 65.8% and 76.3%, respectively, had not changed their overwhelming non-CAS routines, with 32.9% and 19.7% saying clinical trial results moved them toward CEA.
  
  
  CONCLUSIONS
  A 2009 survey of vascular experts found no increase in preference for CAS as a treatment option for advanced carotid bifurcation atherosclerosis. This, in combination with the lack of change from and indeed move toward the ''gold-standard'' CEA, demonstrates a general decline in confidence with CAS.
authors.affiliation: Imperial College London, Department of Vascular Surgery, Charing Cross Hospital, London, UK.
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Malik
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
authors.forename: Roland
authors.initials: R
authors.lastname: Hettige
authors.forename: Alun H
authors.initials: AH
authors.lastname: Davies
mesh_terms: D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D001291:Attitude of Health Personnel; D016893:Carotid Stenosis / Q000601:surgery / Q000628:therapy*; D003697:Delphi Technique; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D015607:Stents; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom