Extracranial Cerebrovascular Disease
Key Points
Key Points
- Over the past two decades, the role and efficacy of carotid endarterectomy (CEA) and carotid artery stenting (CAS) have become established as alternatives to medical therapy for stroke prevention and treatment.
- Recent publications have clarified the management of extracranial carotid disease and prompted this update.
Guideline Recommendations
...uideline Recommendations...
...of Recommendations...
...ptomatic carotid stenosis...
...For low surgical risk patients with asymp...
...ic carotid artery stenosis...
...recommend CEA over TF-CAS in low- and...
.... Management of acute neurologic syndro...
...ts with recent stable stroke (modified Rankin s...
...In patients undergoing revascularization within t...
....3 We recommend against revascularization, rega...
4. Screening
...ecommend against the routine screening for clin...
...d asymptomatic patients who are at...
...In asymptomatic patients who are undergoing screen...
...rotid artery stenosis and coronary artery d...
...For patients with symptomatic carotid stenosis of...
...nts with severe (70%-99%) bilateral a...
....3 In patients requiring carotid in...
Best Practice Recommendations (Implementation Document)
...commendations (Implementation Document)...
...Imaging Indications...
...asound examination preferably performed...
...dical Therapy and Risk Factor Modificat...
...In patients with arteriosclerotic arterial di...
Carotid Intervention Indica...
...gically symptomatic patients with stenosi...
...1. Revascularization Techniques With High-Risk Cr...
...risk Surgical Risk for CEA Based on the Medicare...
...Technical Considerations...
...ice of anesthesia local/regional vs general anes...
...eversion: eversion CEA versus tradition...
...is Level 1 evidence to support a recommendat...
...s for high carotid lesions...
...should anticipate the presence of dis...
...drainage and hematoma after CEA...
...e decision for use of drainage post CEA should be...
...mpletion imaging...
...re is insufficient evidence to recommend routi...
...nagement of carotid coils and kinks...
...ical intervention for asymptomatic i...
...of Carotid Intervention in Stro...
...anagement of acute neurologic...
...s who present in less than 6 hours of ons...
Carotid Artery Sten...
Acces...
...aging of the aortic arch and caroti...
...ical considerati...
...CAS should be performed with distal or proximal pr...
...post-PTA and Stent Selection...
...rotection should be established before PTA during...
...nal CEA Indications and Techniq...
In the appropriate clinical setting, externa...
...cations of Carotid Interventio...
...intraoperative or perioperative stroke...
...nt awakens from CEA under general anesthesia...
...CAS complication
...wing to MCA occlusion owing to embolization a...
...hemodynamic instability after CEA...
...ificant postoperative hypertension or hyp...
...e injury (CNI) after CEA
...rve injuries are best avoided by meticulous know...
...s diagnosed, expectant management is typically ind...
...erioperative MI risk af...
...tive MI after CEA is best avoided by appropri...
...hematoma after CEA...
...ound hematoma is best accomplished using m...
...uld be considered to reverse heparinization. D...
...c patch infection after CE...
...In patients who have undergone CEA with prost...
...stenosis after CEA
...use of patch angioplasty or eversion e...
Restenosis following...
...atic patients (>70% restenosis) should be treate...
...ellaneous...
...Intravenous thrombolysis should be...
...mal Vertebral Artery Disease
...In patients presenting with symptoma...
...phalic Disease and Proximal CCA Occlusive Disease...
...erventions (open or endovascular) to tr...
...and Other Major Noncardiac Surgery...
...oncardiac surgery, preoperative carotid and cerebr...
...d Intervention Surveillance (CEA and CAS)...
...After CEA or CAS, we recommend surveillance with...