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Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis.

Abstract：

BACKGROUND AND PURPOSE:We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis. METHODS:We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used. RESULTS:Thirty-four eligible guidelines were identified from 23 different regions/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for ≈50% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with ≈50% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison. CONCLUSIONS:This systematic review has identified many opportunities to modernize and otherwise improve carotid stenosis management guidelines.

journal_name

Stroke

journal_title

Stroke

authors

Abbott AL,Paraskevas KI,Kakkos SK,Golledge J,Eckstein HH,Diaz-Sandoval LJ,Cao L,Fu Q,Wijeratne T,Leung TW,Montero-Baker M,Lee BC,Pircher S,Bosch M,Dennekamp M,Ringleb P

doi

10.1161/STROKEAHA.115.003390

subject

Has Abstract

pub_date

2015-11-01 00:00:00

pages

3288-301

issue

eissn

0039-2499

issn

1524-4628

pii

STROKEAHA.115.003390

journal_volume

pub_type

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Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis.