Abstract

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.

Links

Publisher Full Text

Authors

Kakisis JD, Avgerinos ED, Antonopoulos CN, Giannakopoulos TG, Moulakakis K, Liapis CD

Institution

Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, 1 Rimini street, Haidari, Athens 12462, Greece. kakisis@med.uoa.gr

Source

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 44:3 2012 Sep pg 238-43

MeSH

Angioplasty
Asymptomatic Diseases
Carotid Stenosis
Endarterectomy, Carotid
Europe
Evidence-Based Medicine
Humans
Patient Selection
Practice Guidelines as Topic
Risk Assessment
Risk Factors
Societies, Medical
Stents
Stroke
Treatment Outcome

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

22658616