Carotid stent guidelines: How the society for vascular surgery (SVS) “had its cake and ate it too”

White, Christopher J.

doi:10.1002/ccd.24397

Cited by 2 publications

(1 citation statement)

References 5 publications

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“…They include treatment selection among the large group of patients with asymptomatic disease and the relative risk for CEA and CAS in other important subgroups depending on age, sex, anatomy, and other treatment-specific risks. Although society guidelines have attempted to address some of these issues, the absence of consensus has also generated controversy 16,[35][36][37] (Table 2).…”

Section: Current Controversies and Future Directionsmentioning

confidence: 99%

Extracranial Carotid Disease Revascularization

Cutlip

Pinto

2012

Circulation

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E xtracranial carotid artery stenosis is a factor in Ϸ20% to 30% of all strokes. 1,2 Revascularization strategies using surgical carotid endarterectomy (CEA) or carotid artery stenting (CAS) offer the possibility of stroke prevention by restoring flow and mitigating the risk for future plaqueassociated embolization. Numerous studies have assessed whether these procedures reduce the risk for stroke and improve overall clinical outcome, but many issues and questions remain. The available clinical outcome data have highlighted the differential risk and benefit among symptomatic versus asymptomatic patients, the impact of older age and sex, and the surgical risk for CEA related to either anatomic or medical factors. Likewise, the important issues of operator training and experience and refinement of technique for both CEA and CAS affect the interpretation of clinical trial results and the generalization of these results to broader populations of patients and operators. To what extent other cardiovascular outcomes such as myocardial infarction (MI) and cardiac death should be incorporated into the interpretation of specific clinical trials for stroke prevention is also an important consideration. Finally, the lack of data for comparing contemporary medical therapy with revascularization for reduction of stroke and overall cardiovascular outcomes is a serious shortfall. This review assesses the results of historical and more recent clinical trials of the comparative effectiveness of carotid revascularization in the context of these clinical issues.

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Section: Current Controversies and Future Directionsmentioning

confidence: 99%