Document Detail


Guidelines for patient selection and performance of carotid artery stenting.
MedLine Citation:
PMID:  20618191     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS.
METHODS: We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC).
RESULTS: Selection of patients suitable for CAS needs careful consideration of clinical and patho-anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and 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 randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre-procedural neuro-imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings.
CONCLUSION: These guidelines represent the consensus of an inter-collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines.
Authors:
; Christopher Bladin; Brian Chambers; Gishel New; Michael Denton; Michael Lawrence-Brown
Publication Detail:
Type:  Journal Article; Practice Guideline    
Journal Detail:
Title:  ANZ journal of surgery     Volume:  80     ISSN:  1445-2197     ISO Abbreviation:  ANZ J Surg     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-12-01     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101086634     Medline TA:  ANZ J Surg     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  398-405     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Carotid Arteries / surgery*
Carotid Stenosis / radiography,  surgery*
Endarterectomy, Carotid*
Humans
Patient Selection
Prosthesis Implantation
Stents*
Investigator
Investigator/Affiliation:
Chris Levi / ; David David Muller / ; Stephen Davis / ; Geoff Donnan / ; Denis Crimmins / ; Judy Frayne / ; Constantine Phatouros / ; Rebecca Scroop / ; Tim Harrington /

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


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