TY - JOUR
TI - The European Society for Vascular Surgery Guidelines for Carotid
Intervention: An Updated Independent Assessment and Literature Review
AU - Kakisis, J. D.
AU - Avgerinos, E. D.
AU - Antonopoulos, C. N. and
AU - Giannakopoulos, T. G.
AU - Moulakakis, K.
AU - Liapis, C. D.
JO - European Journal of Vascular and Endovascular Surgery
PY - 2012
VL - 44
TODO - 3
SP - 238-243
PB - W B SAUNDERS CO LTD
SN - 1078-5884, 1532-2165
TODO - 10.1016/j.ejvs.2012.04.015
TODO - Carotid stenosis; Treatment; Guidelines; Angioplasty; Stenting;
Endarterectomy
TODO - Background and purpose: Many medical societies now recommend carotid
stenting as an alternative to endarterectomy which raises the question
of whether the ESVS guidelines are still valid. This review addresses
the validity of the ESVS guidelines that refer to carotid stenting based
on the evidence available today.
Methods: We conducted a review and meta-analysis based on the original
ESVS guidelines paper and articles published over the past 2 years.
Results: For symptomatic patients, surgery remains the best option,
since stenting is associated with a 61% relative risk increase of
periprocedural stroke or death compared to endarterectomy. However,
centres of excellence in carotid stenting may achieve comparable
results. In asymptomatic patients, there is still no good evidence for
any intervention because the stroke risk from an asymptomatic stenosis
is very low, especially with the best modern medical treatment. CREST
and CAVATAS have verified that mid-term stroke prevention after
successful stenting is similar to endarterectomy. EVA-3S, SPACE, ICSS
and CREST have provided additional evidence regarding the role of age in
choosing therapeutic modality. The role of the cerebral protection
devices is challenged by the imaging findings of small randomised trials
but supported by large systematic reviews.
Conclusions: The ESVS guidelines that refer to carotid stenting not only
remain valid but also have been further strengthened by the latest
available clinical data. An update of these guidelines including all of
the recent evidence is needed to provide an objective and up-to-date
interpretation of the data. (C) 2012 European Society for Vascular
Surgery. Published by Elsevier Ltd. All rights reserved.
ER -