Extracranial Cerebrovascular Disease

Publication Date: June 18, 2021

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 Recommendation...

...y of Recommendations...

...ymptomatic carotid stenosis...

...surgical risk patients with asymptomatic carot...

...tomatic carotid artery stenosis...

...d CEA over TF-CAS in low- and standard...

...of acute neurologic syndrome...

...nts with recent stable stroke (modified Ra...

...2 In patients undergoing revascularization withi...

...We recommend against revascularization, r...

...creening...

...e recommend against the routine screening for cl...

...ed asymptomatic patients who are at an in...

...omatic patients who are undergoing scree...

...rotid artery stenosis and coronary artery disea...

...patients with symptomatic carotid stenosis of...

...patients with severe (70%-99%) bilateral asympto...

...atients requiring carotid intervention,...


Best Practice Recommendations (Implementation Document)

...ractice Recommendations (Implementatio...

...id Imaging Indications...

...uplex ultrasound examination preferably performed...


...dical Therapy and Risk Factor Modification...

...n patients with arteriosclerotic arterial dis...


...d Intervention Indications...

...or neurologically symptomatic patient...


...ularization Techniques With High-Risk C...


.... High-risk Surgical Risk for CEA Ba...


...A Technical Considerations

...oice of anesthesia local/regional vs gener...

...ersion: eversion CEA versus traditional endarte...

...ere is Level 1 evidence to support a recommendati...

...ical tips for high carotid lesion...

Surgeons should anticipate the presence of d...

...drainage and hematoma after C...

...decision for use of drainage post CE...

...ompletion ima...

...sufficient evidence to recommend routine u...

Management of carotid coi...

Surgical intervention for asymptomatic is...


...Carotid Intervention in Stroke...

...t of acute neurologic synd...

...o present in less than 6 hours of onset of s...


...Artery Stenting...

Acce...

...ng of the aortic arch and carotid bifurcation is r...

...al considerations...

...Transfemoral CAS should be perfo...

...post-PTA and Stent Selection...

...otection should be established before PTA duri...


External CEA Indications and Technique...

...the appropriate clinical setting,...


...cations of Carotid Intervention...

...ntraoperative or perioperative stroke with CEA...

...If a patient awakens from CEA under...

...CAS complication...

...Stroke owing to MCA occlusion owin...

...hemodynamic instability after CEA...

...Significant postoperative hypertension o...

...anial nerve injury (CNI) after CEA...

...njuries are best avoided by meticulous knowle...

...Once a CNI is diagnosed, expectant manageme...

...tive MI risk after CEA...

...Perioperative MI after CEA is best avoid...

...d hematoma after CEA...

...wound hematoma is best accomplishe...

...ould be considered to reverse heparinization....

...c patch infection after CEA...

...atients who have undergone CEA with prosth...

...estenosis after CE...

...f patch angioplasty or eversion endarterectom...

...estenosis following CAS...

...Most asymptomatic patients (>70% restenosis...


...scellaneous...

...travenous thrombolysis should be administered...


...ertebral Artery Disease...

...patients presenting with symptomatic...


...achiocephalic Disease and Proximal CCA O...

...terventions (open or endovascular) to treat p...


...rotid Disease and Other Major Nonc...

...e noncardiac surgery, preoperative carotid...


...ntervention Surveillance (CEA and C...

...CEA or CAS, we recommend surveillance with du...