Document Detail


Guidelines for patient selection and performance of carotid artery stenting.
MedLine Citation:
PMID:  20002285     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy (CEA) remains the benchmark in terms of procedural mortality and morbidity. Consensus Australasian guidelines for the safe performance of CAS were developed using the modified Delphi consensus method of iterative consultation. Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria. Randomised controlled trials and pooled analyses have demonstrated that CAS is more hazardous than CEA. The CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. There is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomised controlled trials, carotid and aortic arch anatomy and pathology, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuroimaging and peri-procedural, independent, neurological assessment. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programmes. These standards should apply in the public and private health-care settings. These guidelines represent the consensus of an intercollegiate committee in order to direct appropriate patient selection to perform CAS. Advances in endovascular technologies and the results of randomised controlled trials will guide future revisions of this document.
Authors:
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of medical imaging and radiation oncology     Volume:  53     ISSN:  1754-9485     ISO Abbreviation:  J Med Imaging Radiat Oncol     Publication Date:  2009 Dec 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-03-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101469340     Medline TA:  J Med Imaging Radiat Oncol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  538-45     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Australia
Blood Vessel Prosthesis*
Carotid Stenosis / diagnosis,  surgery*
Endarterectomy, Carotid / instrumentation*,  standards*
Humans
Patient Selection*
Practice Guidelines as Topic*
Stents / standards*
Investigator
Investigator/Affiliation:
Christopher Bladin / ; Brian Chambers / ; Denis Crimmins / ; Stephen Davis / ; Geoff Donnan / ; Judy Frayne / ; Chris Levi / ; David Muller / ; Gishel New / ; Michael Denton / ; Michael Lawrence-Brown / ; Constantine Phatouros / ; Rebecca Scroop / ; Tim Harrington /

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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