Atherosclerotic Disease of the Carotid Artery Guidelines

Updated: Sep 29, 2021
  • Author: Jake F Hemingway, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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Guidelines

SVS Guidelines for Management of Extracranial Cerebrovascular Disease

In June 2021, the Society for Vascular Surgery (SVS) published clinical practice guidelines for management of extracranial cerebrovascular disease. [26] Recommendations included the following:

  • Carotid endarterectomy (CEA) is recommended as first-line treatment for symptomatic low-risk surgical patients with stenosis of 50-99% and asymptomatic patients with stenosis of 70-99%.
  • Carotid revascularization is appropriate for symptomatic patients with recent stable stroke and >50% stenosis. It should be performed as soon as the patient is neurologically stable (after 48 hr but before 14 d from symptom onset).
  • Screening for clinically asymptomatic carotid artery stenosis in patients without symptoms or risk factors for carotid artery disease is not recommended.
  • In selected asymptomatic patients at increased risk for carotid stenosis, screening for clinically asymptomatic carotid artery stenosis is suggested, as long as the patients are potentially fit for and willing to consider carotid intervention upon discovery of significant stenosis.
  • In patients with symptomatic carotid stenosis of 50-99% who require both CEA and coronary artery bypass grafting (CABG), CEA before or concomitant with CABG is suggested.