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==Guidelines== | ==Guidelines== | ||
=== 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<ref name=":2" /> === | |||
* 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. (Class I; ''Level of Evidence: C'') | |||
* It is reasonable to perform CEA in asymptomatic patients who have more than 70% stenosis of the internal carotid artery if the risk of perioperative stroke, MI, and death is low. (Class IIa; ''Level of Evidence: A'') | |||
* In symptomatic or asymptomatic patients at high risk of complications for | |||
carotid revascularization by either CEA or CAS because of comorbidities, the effectiveness of revascularization versus medical therapy alone is not well established. (Class IIb; ''Level of Evidence: B'') | |||
==Design== | ==Design== | ||
<!-- This section provides a bulleted-list summary of your trial's design. Use the ACCORD trial as a template. Don't worry about the asterisks; they're just bullets for a bulleted list. --> | <!-- This section provides a bulleted-list summary of your trial's design. Use the ACCORD trial as a template. Don't worry about the asterisks; they're just bullets for a bulleted list. --> | ||
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* Medical therapy was not standardized and left to the discretion of clinicians.<ref name=":1">[http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0066325/ Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, ''et al.'' Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force. Evidence Synthesis No. 111. AHRQ Publication No. 13-05178-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014]</ref> | * Medical therapy was not standardized and left to the discretion of clinicians.<ref name=":1">[http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0066325/ Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ, ''et al.'' Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-Analysis for the U.S. Preventive Services Task Force. Evidence Synthesis No. 111. AHRQ Publication No. 13-05178-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014]</ref> | ||
* Surgeons in the trial were highly selected. It's important to consider if a comparable incidence of operative complications can be achieved in local centres.<ref name=":0" /> | * Surgeons in the trial were highly selected. It's important to consider if a comparable incidence of operative complications can be achieved in local centres.<ref name=":0" /> | ||
* It is unclear if females obtain as much benefit as males from CEA.<ref>[http://content.onlinejacc.org/article.aspx?articleid=1144187 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline | * It is unclear if females obtain as much benefit as males from CEA.<ref name=":2">[http://content.onlinejacc.org/article.aspx?articleid=1144187 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. <em>J Am Coll Cardiol</em>. 2011;57(8):e16-e94] | on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. <em>J Am Coll Cardiol</em>. 2011;57(8):e16-e94] | ||
</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/15451212 Rothwell PM. ACST: which subgroups will benefit most from carotid endarterectomy? ''Lancet''. 2004;364(9440):1122-3; author reply 1125-6]</ref> | </ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/15451212 Rothwell PM. ACST: which subgroups will benefit most from carotid endarterectomy? ''Lancet''. 2004;364(9440):1122-3; author reply 1125-6]</ref> | ||