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
...Guideline Rec...
...Summary of Rec...
...1. Asym...
...low surgical risk patients with asym...
...2. Symptoma...
...We recommend CEA over TF-CAS in low-...
...3. Management...
...ients with recent stable stroke (modified Ranki...
3.2 In patients undergoing revasculari...
...We recommend against revascularization,...
...4. Screening...
...We recommend against the routine screening fo...
...asymptomatic patients who are at a...
...atic patients who are undergoing scre...
...5. Combine...
...ts with symptomatic carotid stenos...
...2. In patients with severe (70%-99%) bilate...
...tients requiring carotid intervention,...
Best Practice Recommendations (Implementation Document)
...Best Pra...
...sound examination preferably performe...
...Optimal Medical Therapy...
...In patients with arteriosclerotic arterial disea...
...Carotid Intervention Indi...
...For neurologically symptomatic pat...
...ascularization Techniques With High-Risk Criteria...
...risk Surgical Risk for CEA Based on the Medicare N...
...CEA Technical Co...
...ice of anesthesia local/regional vs...
...Caro...
...here is Level 1 evidence to support a r...
...Technical tip...
...geons should anticipate the presence of di...
...Wound dr...
...for use of drainage post CEA should be left...
...Complet...
...insufficient evidence to recommend routine...
...Mana...
...Surgical intervention for asymptomatic isola...
...Timing of Carotid Interv...
...Management of ac...
...present in less than 6 hours of onset of stroke...
...Carotid Artery St...
...Acce...
...g of the aortic arch and carotid bifurcati...
...Technical considerations...
...Transfemoral CAS should be performed wit...
...Pre-PTA and p...
...Protection should be established before PT...
...External CE...
...n the appropriate clinical setting...
...Complications of Ca...
...Management of in...
...nt awakens from CEA under general anesthesi...
...Acute C...
...owing to MCA occlusion owing to em...
...Postoperative hemody...
...nt postoperative hypertension or hypo...
...Cra...
...injuries are best avoided by metic...
...e a CNI is diagnosed, expectant manageme...
...Perioperative MI...
...Perioperative MI after CEA is best avoided by a...
...Wound hematoma af...
...ance of wound hematoma is best accom...
...amine should be considered to revers...
...Prosthetic patch...
...s who have undergone CEA with prosth...
...Re...
...The use of patch angioplasty or ever...
...Restenosi...
...asymptomatic patients (>70% restenosis) sh...
...Miscellaneous...
...Intravenous thrombolysis should be administere...
...ients presenting with symptomatic vertebr...
...Brachiocephalic...
...Interventions (open or endovascula...
...Carotid Disea...
...noncardiac surgery, preoperative ca...
...Post Caro...
...EA or CAS, we recommend surveillance...