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
...deline Recommenda...
...of Recommendations...
...Asymptomatic carotid steno...
...or low surgical risk patients with asymptomatic...
...ic carotid artery stenosis...
...e recommend CEA over TF-CAS in low- and...
...ent of acute neurologic syndrome...
...ts with recent stable stroke (modified Ranki...
...undergoing revascularization within the f...
3.3 We recommend against revasculariz...
...creening...
...e recommend against the routine screening for c...
...In selected asymptomatic patients who are...
...n asymptomatic patients who are undergoin...
...tid artery stenosis and coronary a...
...tients with symptomatic carotid stenos...
...In patients with severe (70%-99%) bilate...
...tients requiring carotid intervention, stage...
Best Practice Recommendations (Implementation Document)
...st Practice Recommendations (Implemen...
...arotid Imaging Indications
...Duplex ultrasound examination pr...
...al Therapy and Risk Factor Modification...
...ts with arteriosclerotic arterial disease, we re...
...tervention Indications...
...or neurologically symptomatic patients...
...1. Revascularization Techniques W...
...ble 2. High-risk Surgical Risk for CEA Based o...
...Technical Considera...
...choice of anesthesia local/regional vs g...
...ion: eversion CEA versus traditional endarter...
...is Level 1 evidence to support a recomme...
Technical tips for high ca...
...ons should anticipate the presence of distal dis...
...und drainage and hematoma after CEA...
...ion for use of drainage post CEA should be...
...pletion imaging...
...fficient evidence to recommend routine use of comp...
...nagement of carotid coils and...
...Surgical intervention for asymptomat...
...ng of Carotid Intervention...
...gement of acute neurologic syndrom...
Patients who present in less th...
...d Artery Stenting...
...cess
...ging of the aortic arch and carotid bifurcation is...
...hnical considera...
...nsfemoral CAS should be performed with distal or...
...TA and post-PTA and Stent Select...
...should be established before PTA during CAS. Pr...
...CEA Indications and Techniques...
...he appropriate clinical setting, external CEA a...
...mplications of Carotid Interv...
...ent of intraoperative or perioperative stroke with...
...If a patient awakens from CEA under general an...
...ute CAS complica...
...ke owing to MCA occlusion owing to embol...
...ative hemodynamic instability after CEA...
...ant postoperative hypertension or hypote...
...ve injury (CNI) after CEA...
...ial nerve injuries are best avoided...
...ce a CNI is diagnosed, expectant management is...
...rative MI risk after CE...
...perative MI after CEA is best avoided...
...ematoma after CEA...
...e of wound hematoma is best accomplished using...
...uld be considered to reverse heparinization...
...osthetic patch infection after...
...In patients who have undergone CEA with prosth...
...stenosis after...
...se of patch angioplasty or eversion enda...
...sis following CAS...
...matic patients (>70% restenosis) should be treated...
...cellaneous
...s thrombolysis should be administered as first...
...Vertebral Artery Disea...
In patients presenting with sympt...
...lic Disease and Proximal CCA Occlusive Disea...
...ns (open or endovascular) to treat proximal C...
...ease and Other Major Noncardiac Surger...
...fore noncardiac surgery, preoperative caroti...
...tid Intervention Surveillance (CEA and CAS)...
...ter CEA or CAS, we recommend surveillance with...