Selection of Patients for Carotid Revascularization
Carotid artery stenosis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Selection of Patients for Carotid Revascularization
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 (DO NOT EDIT)[1]
Recommendations for Selection of Patients for Carotid Revascularization
Class I |
"1. Patients at average or low surgical risk who experience nondisabling ischemic stroke† or transient cerebral ischemic symptoms, including hemispheric events or amaurosis fugax, within 6 months (symptomatic patients) should undergo CEA if the diameter of the lumen of the ipsilateral internal carotid artery is reduced more than 70%‡ as documented by noninvasive imaging (Level of Evidence: A)" or more than 50% as documented by catheter angiography (Level of Evidence: B)" and the anticipated rate of perioperative stroke or mortality is less than 6%. |
"2. CAS is indicated as an alternative to CEA for symptomatic patients at average or low risk of complications associated with endovascular intervention when the diameter of the lumen of the internal carotid artery is reduced by more than 70% as documented by noninvasive imaging or more than 50% as documented by catheter angiography and the anticipated rate of periprocedural stroke or mortality is less than 6% (Level of Evidence: B)" |
"3. Selection of asymptomatic patients for carotid revascularization should be guided by an assessment of comorbid conditions, life expectancy, and other individual factors and should include a thorough discussion of the risks and benefits of the procedure with an understanding of patient preferences. (Level of Evidence: C)" |
Class III (Harm) | ||||||||
"1. Except in extraordinary circumstances, carotid revascularization by either CEA or CAS is not recommended when atherosclerosis nar- rows the lumen by less than 50% (Level of Evidence: A) " | ||||||||
"2. Carotid revascularization is not recommended for patients with chronic total occlusion of the targeted carotid artery. (Level of Evidence: C) " | ||||||||
"3. Carotid revascularization is not recommended for patients with severe disability¶ caused by cerebral infarction that precludes preservation of useful function. (Level of Evidence: C) "
References
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