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
...ine Recommendations...
...mmary of Recommendatio...
...omatic carotid stenosis
...rgical risk patients with asymptomatic carotid...
...tomatic carotid artery stenosi...
...We recommend CEA over TF-CAS in lo...
...Management of acute neurologi...
...with recent stable stroke (modified Rankin...
...ts undergoing revascularization within...
...recommend against revascularization, regar...
...creening
...We recommend against the routine screening fo...
...lected asymptomatic patients who are at an increa...
...asymptomatic patients who are underg...
...Combined carotid artery stenosis...
....1. For patients with symptomatic carotid stenos...
...ts with severe (70%-99%) bilateral asymptom...
...s requiring carotid intervention, stage...
Best Practice Recommendations (Implementation Document)
...actice Recommendations (Implementation Document)...
...rotid Imaging Indic...
...lex ultrasound examination prefera...
...l Therapy and Risk Factor Modification...
...In patients with arteriosclerotic...
...rotid Intervention Indic...
...For neurologically symptomatic patients w...
...able 1. Revascularization Techniques With High-Ris...
...isk Surgical Risk for CEA Based on the Med...
...Technical Considerations...
...The choice of anesthesia local/regional vs...
...d eversion: eversion CEA versus traditional...
...Level 1 evidence to support a reco...
...s for high carotid lesions...
...should anticipate the presence of distal dis...
...ound drainage and hematoma after...
...ision for use of drainage post CEA should be left...
...tion imaging...
There is insufficient evidence to recomme...
...f carotid coils and kinks...
...cal intervention for asymptomatic is...
...rotid Intervention in Stroke...
...agement of acute neurologic syndrome...
...atients who present in less than 6 hours...
...arotid Artery Stent...
...cces...
Proper imaging of the aortic arch and carotid...
...l considerations
Transfemoral CAS should be performed with di...
Pre-PTA and post-PTA and St...
...tion should be established before PTA...
...CEA Indications and Techniques
...riate clinical setting, external C...
...plications of Carotid Intervent...
...nagement of intraoperative or periope...
...If a patient awakens from CEA under general an...
...e CAS complication...
Stroke owing to MCA occlusion o...
...toperative hemodynamic instability a...
...ignificant postoperative hypertension or hypote...
...l nerve injury (CNI) after CEA...
Cranial nerve injuries are best avoided by me...
...a CNI is diagnosed, expectant management is typ...
...rioperative MI risk after CEA...
...operative MI after CEA is best avoi...
...und hematoma aft...
...ound hematoma is best accomplished using me...
...should be considered to reverse heparinization....
...ic patch infection after CEA
...n patients who have undergone CEA with pr...
...stenosis after C...
...patch angioplasty or eversion endarter...
...stenosis followi...
...matic patients (>70% restenosis) sho...
...scellaneous...
Intravenous thrombolysis should be administere...
...Vertebral Artery Disease
...presenting with symptomatic verte...
...rachiocephalic Disease and Proximal...
...ntions (open or endovascular) to treat proximal CC...
...arotid Disease and Other Major Noncardiac Su...
...ore noncardiac surgery, preoperative carotid...
...tervention Surveillance (CEA and CAS)...
...or CAS, we recommend surveillance with...