title: A Protocol-Based Decision for Choosing a Proper Surgical Treatment Option for Carotid Artery Stenosis.
abstract: OBJECTIVE
  There are two established surgical treatment options for carotid artery stenosis. Carotid endarterectomy (CEA) has been accepted as a gold standard for surgical treatment while carotid artery stenting (CAS) has recently become an alternative option. Each treatment option has advantages and disadvantages for the treatment outcomes. We propose a protocol for selection of a proper surgical treatment option for carotid artery stenosis.
  
  
  METHODS
  A total of 192 published articles on management of carotid artery stenosis were reviewed. Preoperatively considerable factors which had been repeatedly noted in those articles for the risk/benefits of CEA or CAS were selected. According to those factors, a protocol with four categories was established.
  
  
  RESULTS
  CEA or CAS is indicated when the patient has a symptomatic stenosis ≥ 50%, or when the patient has an asymptomatic stenosis ≥ 80%. Each treatment option has absolute indications and favorable indications. Each absolute indication is scored with three points, and each favorable indication, one point. Based on the highest scores, a proper treatment option (CEA or CAS) is selected.
  
  
  CONCLUSIONS
  We have been treating patients according to this protocol and evaluating the outcomes of our protocol-based decision because this protocol might be helpful in assessment of risk/benefit for selection of a proper surgical treatment option in patients with carotid artery stenosis.
authors.affiliation: Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: E-Wook
authors.initials: EW
authors.lastname: Jang
authors.affiliation: Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea. ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Joonho
authors.initials: J
authors.lastname: Chung
authors.affiliation: Department of Neurology, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea.
authors.forename: Kwon-Duk
authors.initials: KD
authors.lastname: Seo
authors.affiliation: Department of Radiology, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea. ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Suh
authors.affiliation: Department of Neurosurgery, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea. ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Yong Bae
authors.initials: YB
authors.lastname: Kim
authors.affiliation: Department of Neurology, Cerebrovascular Center, Gangnam Severance Hospital, Seoul, Korea. ; Severance Institute for Vascular and Metabolic Research, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyung-Yul
authors.initials: KY
authors.lastname: Lee
keywords: Carotid artery stenosis; Carotid artery stenting; Carotid endarterectomy; Protocol