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
...line Recommendations...
...y of Recommendatio...
...Asymptomatic carotid steno...
....1 For low surgical risk patients with...
...matic carotid artery stenosis...
...mend CEA over TF-CAS in low- and standard-risk pat...
...of acute neurologic syndrome
...patients with recent stable stroke (modifi...
...tients undergoing revascularization within t...
...mend against revascularization, regardless of...
...Screening...
...against the routine screening for clinic...
...d asymptomatic patients who are at an increased ri...
...ptomatic patients who are undergoing scr...
...bined carotid artery stenosis and coronary art...
...or patients with symptomatic carotid stenosis...
...ients with severe (70%-99%) bilateral...
...nts requiring carotid intervention, staged or sync...
Best Practice Recommendations (Implementation Document)
...Recommendations (Implementation Doc...
...arotid Imaging Indic...
...uplex ultrasound examination preferably perf...
...Medical Therapy and Risk Factor Modification...
...with arteriosclerotic arterial disease, we...
...tid Intervention Indications...
...or neurologically symptomatic patien...
...ble 1. Revascularization Techniques With Hig...
Table 2. High-risk Surgical Risk for CEA Based o...
...echnical Considerations
...he choice of anesthesia local/regional vs g...
...rsion: eversion CEA versus traditional endarte...
...e is Level 1 evidence to support a recommendati...
...ical tips for high carotid lesions...
...Surgeons should anticipate the presence of dista...
...und drainage and hematoma after C...
...decision for use of drainage post CEA s...
...ompletion imagin...
...e is insufficient evidence to recomm...
...ment of carotid coils and ki...
...al intervention for asymptomatic isolated coil...
...ing of Carotid Intervention in Stroke...
Management of acute neurologic s...
...Patients who present in less than 6 hours...
...tid Artery Stent...
Acces...
...aging of the aortic arch and carotid...
...cal considerations
...Transfemoral CAS should be performed with...
...ost-PTA and Stent Selection...
...n should be established before PTA during CAS...
...l CEA Indications and Techniques...
In the appropriate clinical setting, external...
...ions of Carotid Intervention...
...of intraoperative or perioperative stroke with CE...
If a patient awakens from CEA und...
Acute CAS complication
...ng to MCA occlusion owing to embolization after...
Postoperative hemodynamic instability...
...nt postoperative hypertension or hypo...
...erve injury (CNI) after CEA...
...nial nerve injuries are best avoid...
...Once a CNI is diagnosed, expectant...
Perioperative MI risk after...
...MI after CEA is best avoided by approp...
...nd hematoma after CEA...
...oidance of wound hematoma is best accomplished usi...
...mine should be considered to reverse heparinizatio...
...ic patch infection after CEA...
...In patients who have undergone CEA w...
...osis after CEA...
...patch angioplasty or eversion endartere...
...enosis following CAS
...omatic patients (>70% restenosis) shou...
Miscellan...
...ravenous thrombolysis should be administered...
...mal Vertebral Artery Disease
...resenting with symptomatic vertebral dise...
...c Disease and Proximal CCA Occlusive Disease...
...ventions (open or endovascular) to treat proxim...
...id Disease and Other Major Noncardiac S...
...fore noncardiac surgery, preoperative...
Post Carotid Intervention Surveillance (CEA an...
...A or CAS, we recommend surveillance with duplex...