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

...line Recommendatio...

...y of Recommendations

.... Asymptomatic carotid stenosi...

...r low surgical risk patients with asymptomatic...

...Symptomatic carotid artery stenosis

...mmend CEA over TF-CAS in low- and standa...

...Management of acute neurolo...

...ents with recent stable stroke (modi...

...undergoing revascularization within the f...

...mend against revascularization, rega...

...Screenin...

...end against the routine screening for...

...ed asymptomatic patients who are at...

...symptomatic patients who are undergoing scr...

...bined carotid artery stenosis and c...

...For patients with symptomatic caroti...

...atients with severe (70%-99%) bila...

...requiring carotid intervention, staged or...


Best Practice Recommendations (Implementation Document)

...e Recommendations (Implementation D...

...d Imaging Indications...

...plex ultrasound examination preferably performed i...


...Therapy and Risk Factor Modification...

...ients with arteriosclerotic arterial disease, we...


...otid Intervention Indications

...neurologically symptomatic patient...


...able 1. Revascularization Techniques Wit...


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


...A Technical Considerati...

...The choice of anesthesia local/regional vs...

...version: eversion CEA versus traditional endart...

...here is Level 1 evidence to support a...

...echnical tips for high carotid lesi...

...eons should anticipate the presence...

...drainage and hematoma after CE...

...The decision for use of drainage pos...

...mpletion imaging...

...s insufficient evidence to recommend routine...

...ement of carotid coils and...

...Surgical intervention for asymptomati...


...Carotid Intervention in Stroke...

...of acute neurologic syndrom...

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


...otid Artery Sten...

Access

...oper imaging of the aortic arch and caroti...

...nical considerat...

...Transfemoral CAS should be performed with dista...

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

...rotection should be established befo...


...Indications and Techniques...

...In the appropriate clinical setting...


...mplications of Carotid Intervention...

...agement of intraoperative or perio...

...nt awakens from CEA under general anes...

...cute CAS complica...

...Stroke owing to MCA occlusion owing to emboli...

...emodynamic instability after CEA...

Significant postoperative hypertension or h...

...e injury (CNI) after CEA...

...nerve injuries are best avoided by meticul...

...I is diagnosed, expectant management is...

...perative MI risk after CEA...

Perioperative MI after CEA is best avoi...

...hematoma after CEA...

Avoidance of wound hematoma is best...

...amine should be considered to reverse heparini...

...thetic patch infection after CEA

...atients who have undergone CEA with prosthet...

...stenosis after CE...

...patch angioplasty or eversion endarterectomy is...

...is following CAS...

...omatic patients (>70% restenosis) should be t...


...iscellaneous

Intravenous thrombolysis should be...


...mal Vertebral Artery Dis...

...tients presenting with symptomatic verteb...


...c Disease and Proximal CCA Occlusive Disease...

...ventions (open or endovascular) to treat pro...


Carotid Disease and Other Major Non...

...Before noncardiac surgery, preoperative c...


...arotid Intervention Surveillance (CEA...

...r CAS, we recommend surveillance with duplex ult...