title: Management of carotid stenosis in women: consensus document.
abstract: Specific guidelines for management of cerebrovascular risk in women are currently lacking. This study aims to provide a consensus expert opinion to help make clinical decisions in women with carotid stenosis.
  
  
  
  Proposals for the use of carotid endarterectomy (CEA), carotid stenting (CAS), and medical therapy for stroke prevention in women with carotid stenosis were provided by a group of 9 international experts with consensus method.
  
  
  
  Symptomatic women with severe carotid stenosis can be managed by CEA provided that the perioperative risk of the operators is low (<4%). Periprocedural stroke risks may be increased in symptomatic women if revascularization is performed by CAS; however, the choice of CAS vs CEA can be tailored in subgroups best fit for each procedure (e.g., women with restenosis or severe coronary disease, best suited for CAS; women with tortuous vessels or old age, best suited for CEA). There is currently limited evidence to consider medical therapy alone as the best choice for women with neurologically severe asymptomatic carotid stenosis, who should be best managed within randomized trials including a medical arm. Medical management and cardiovascular risk factor control must be implemented in all women with carotid stenosis in periprocedural period and lifelong regardless of whether or not intervention is planned.
  
  
  
  The suggestions provided in this article may constitute a decision-making basis for planning treatment of carotid stenosis in women. Most recommendations are of limited strength; however, it is unlikely that new robust data will emerge soon to induce relevant changes.
authors.affiliation: Vascular and Endovascular Surgery, Hospital S.M. Misericordia, Perugia, Italy. plderango@gmail.com
authors.forename: Paola
authors.initials: P
authors.lastname: De Rango
authors.forename: Martin M
authors.initials: MM
authors.lastname: Brown
authors.forename: Didier
authors.initials: D
authors.lastname: Leys
authors.forename: Leys
authors.initials: L
authors.lastname: Didier
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.forename: Wesley S
authors.initials: WS
authors.lastname: Moore
authors.forename: Maurizio
authors.initials: M
authors.lastname: Paciaroni
authors.forename: Peter
authors.initials: P
authors.lastname: Ringleb
authors.forename: Caron
authors.initials: C
authors.lastname: Rockman
authors.forename: Valeria
authors.initials: V
authors.lastname: Caso
mesh_terms: D016893:Carotid Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D016894:Endarterectomy, Carotid / Q000379:methods; D005260:Female; D006801:Humans; D015607:Stents