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#  
 
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]===
 
#  (Level of Evidence: C)
# (Level of Evidence: C)
# (Level of Evidence: C)
# (Level of Evidence: C)
# (Level of Evidence: C)
===[[ACC AHA guidelines classification scheme#Classification of Recommendations|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)
# 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)
# CTA is reasonable in patients who are not candidates for MRA because of claustrophobia, implanted pacemakers, or other incompatible devices. (Level of Evidence: C)
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| 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>
| 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>
|}
|}
*In revascularization candidates


{|class="wikitable"
{|class="wikitable"
|-
|-
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
|-
|-
|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>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' MRA or CTA can be useful when carotid duplex ultrasonography is nondiagnostic.([[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.''' 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. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
 
|-
|-
|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>
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Catheter-based angiography can be useful when noninvasive imaging is not sufficient. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>|}
|}




Revision as of 13:25, 3 October 2012

Carotid artery stenosis Microchapters

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Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Carotid artery stenosis from other Diseases

Epidemiology and Demographics

Risk Factors

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Natural History, Complications and Prognosis

Diagnosis

Diagnostic Testing Guidelines

History and Symptoms

Physical Examination

Laboratory Findings

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MRI

MRA

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Other Imaging Findings

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Treatment

Medical Therapy

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Cost-Effectiveness of Therapy

Future or Investigational Therapies

ACC/AHA Guideline Recommendations

Diagnostic Testing Guidelines Recommendation

Primary Prevention and Screening Guidelines Recommendations

Secondary Prevention Guidelines Recommendations

Selection of Patients for Carotid Revascularization

Periprocedural Management of Patients Undergoing Carotid Endarterectomy

Management of Patients Undergoing Carotid Artery Stenting

Restenosis After Carotid Endarterectomy or Stenting

Vascular Imaging in Patients With Vertebral Artery Disease

Atherosclerotic Risk Factors in Patients With Vertebral Artery Disease

Occlusive Disease of the Subclavian and Brachiocephalic Arteries

Fibromuscular Dysplasia

Cervical Artery Dissection

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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)

“


Class IIa

  1. (Level of Evidence: C)
  2. (Level of Evidence: C)
  3. (Level of Evidence: C)
  4. MRA without contrast is reasonable to assess extent of disease in patients with renal insufficiency or extensive vascular calcification. (Level of Evidence: C)
  5. 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

  1. Duplex carotid ultrasonography might be considered for patients with nonspecific neurological symptoms when cerebral ischemia is a plausible cause. (Level of Evidence: C)
  2. 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)
  3. 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) "
  • In revascularization candidates
Class IIa
"1. MRA or CTA can be useful when carotid duplex ultrasonography is nondiagnostic.(Level of Evidence: C) "
"1. 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) "
"1. Catheter-based angiography can be useful when noninvasive imaging is not sufficient. (Level of Evidence: C) "|}



References

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

  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.
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