Carotid artery stenosis diagnostic testing guidelines: Difference between revisions

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Revision as of 13:23, 3 October 2012

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Charmaine Patel, M.D. [2]

Overview

Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease^[1] (DO NOT EDIT)

“

(Level of Evidence: C)
(Level of Evidence: C)

Class IIa

In revascularization candidates

MRA or CTA can be useful when carotid duplex ultrasonography is nondiagnostic. (Level of Evidence: C)
CTA, MRA or elective cerebral angiography can be useful to search for intracranial vascular disease when an extracranial source of ischemia is not identified or to evaluate severity of stenosis and identify intrathoracic or intracranial vascular lesions not adequately assessed by ultrasonography. (Level of Evidence: C)
Catheter-based angiography can be useful when noninvasive imaging is not sufficient. (Level of Evidence: C)
MRA without contrast is reasonable to assess extent of disease in patients with renal insufficiency or extensive vascular calcification. (Level of Evidence: C)
CTA is reasonable in patients who are not candidates for MRA because of claustrophobia, implanted pacemakers, or other incompatible devices. (Level of Evidence: C)

Class IIb

Duplex carotid ultrasonography might be considered for patients with nonspecific neurological symptoms when cerebral ischemia is a plausible cause. (Level of Evidence: C)
When complete carotid arterial occlusion is suggested by duplex ultrasonography, MRA, or CTA, catheter-based angiography may be considered to determine whether the arterial lumen is sufficient to permit carotid revascularization. (Level of Evidence: C)
Catheter-based angiography may be reasonable in patients with renal dysfunction to limit the amount of radiographic contrast material required for definitive imaging for evaluation of a single vascular territory. (Level of Evidence: C)

”

Class I
"1. Noninvasive imaging for detection of ECVD is recommended in the initial evaluation of patients with transient retinal or hemispheric neurological symptoms of possible ischemic origin. (Level of Evidence: C) "
"2. Duplex ultrasonography is recommended to detect carotid stenosis in patients who develop focal neurological symptoms corresponding to the internal carotid artery territory. (Level of Evidence: C) "
"3. In patients with acute, focal ischemic neurological symptoms corresponding to the territory supplied by the left or right internal carotid artery, magnetic resonance angiography (MRA) or computed tomography angiography (CTA) is indicated to detect carotid stenosis when definitive sonography cannot be obtained. (Level of Evidence: C) "
"4. When intracranial or ECVD is not severe enough to account for neurological symptoms of suspected ischemic origin, echocardiography should be performed seeking a source of cardiogenic embolism. (Level of Evidence: C) "

Class III (Harm)
"1. For women with advanced heart failure symptoms and HCM, pregnancy is associated with excess morbidity/mortality. (Level of Evidence: C) "

Class IIa
"1. For women with HCM whose symptoms are controlled (mild to moderate), pregnancy is reasonable, but expert maternal/fetal medical specialist care, including cardiovascular and prenatal monitoring, is advised. (Level of Evidence: C) "

References

http://my.americanheart.org/idc/groups/ahamah-public/@wcm/@sop/@spub/documents/downloadable/ucm_430166.pdf

↑ Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL; et al. (2011). "2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery". Circulation. 124 (4): 489–532. doi:10.1161/CIR.0b013e31820d8d78. PMID 21282505.

[pmid21282505-1] Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL; et al. (2011). "2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery". Circulation. 124 (4): 489–532. doi:10.1161/CIR.0b013e31820d8d78. PMID 21282505.

[1]

@@ Line 7: / Line 7: @@
 ==Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease<ref name="pmid21282505">{{cite journal| author=Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL et al.| title=2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. | journal=Circulation | year= 2011 | volume= 124 | issue= 4 | pages= 489-532 | pmid=21282505 | doi=10.1161/CIR.0b013e31820d8d78 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21282505  }} </ref> (DO NOT EDIT)==
 {{cquote|
-===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]===
-# Noninvasive imaging for detection of ECVD is recommended in the initial evaluation of patients with transient retinal or hemispheric neurological symptoms of possible ischemic origin. (Level of Evidence: C)
-# Duplex ultrasonography is recommended to detect carotid stenosis in patients who develop focal neurological symptoms corresponding to the internal carotid artery territory. (Level of Evidence: C)
+#
-# In patients with acute, focal ischemic neurological symptoms corresponding to the territory supplied by the left or right internal carotid artery, magnetic resonance angiography (MRA) or computed tomography angiography (CTA) is indicated to detect carotid stenosis when definitive sonography cannot be obtained. (Level of Evidence: C)
+# (Level of Evidence: C)
-# When intracranial or ECVD is not severe enough to account for neurological symptoms of suspected ischemic origin, echocardiography should be performed seeking a source of cardiogenic embolism.(Level of Evidence: C)
+# (Level of Evidence: C)
 ===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
 *In revascularization candidates
@@ Line 23: / Line 23: @@
 # When complete carotid arterial occlusion is suggested by duplex ultrasonography, MRA, or CTA, catheter-based angiography may be considered to determine whether the arterial lumen is sufficient to permit carotid revascularization. (Level of Evidence: C)
 # Catheter-based angiography may be reasonable in patients with renal dysfunction to limit the amount of radiographic contrast material required for definitive imaging for evaluation of a single vascular territory. (Level of Evidence: C)}}
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Noninvasive imaging for detection of ECVD is recommended in the initial evaluation of patients with transient retinal or hemispheric neurological symptoms of possible ischemic origin. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Duplex ultrasonography is recommended to detect carotid stenosis in patients who develop focal neurological symptoms corresponding to the internal carotid artery territory. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' In patients with acute, focal ischemic neurological symptoms corresponding to the territory supplied by the left or right internal carotid artery, magnetic resonance angiography (MRA) or computed tomography angiography (CTA) is indicated to detect carotid stenosis when definitive sonography cannot be obtained.  ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|-
+| bgcolor="LightGreen"|<nowiki>"</nowiki>'''4.''' When intracranial or ECVD is not severe enough to account for neurological symptoms of suspected ischemic origin, echocardiography should be performed seeking a source of cardiogenic embolism. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|}
+{|class="wikitable"
+|-
+|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
+|-
+|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' For women with advanced heart failure symptoms and HCM, pregnancy is associated with excess morbidity/mortality. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|}
+{|class="wikitable"
+|-
+| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
+|-
+|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' For women with HCM whose symptoms are controlled (mild to moderate), pregnancy is reasonable, but expert maternal/fetal medical specialist care, including cardiovascular and prenatal monitoring, is advised. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
+|}
 ==References==

Carotid artery stenosis diagnostic testing guidelines: Difference between revisions

Revision as of 13:23, 3 October 2012

Overview

Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease[1] (DO NOT EDIT)

Class IIa

Class IIb

References

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Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease: Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease^[1] (DO NOT EDIT)