Patient-specific Treatment Allocation for Carotid Artery Disease
Different approaches can be followed to allocate patients eligible for carotid revascularization to either stenting or endarterectomy. Recently, the Society for Vascular Surgery published in their clinical practice guidelines for carotid revascularization an allocation algorithm based on the patients’ surgical risk. Although the algorithm is firmly based on the available evidence from different randomized controlled trials, taking into account more recently published data on the same trials and the constant evolution in interventional techniques, it is questionable whether this conventional algorithm will resist time. An alternative algorithm allocating patients to either carotid endarterectomy or stenting is based on published high-patient and lesion profiles for suboptimal carotid artery stenting outcome. It was successfully introduced in two high-volume centers and might help in lowering the 30-day complication rates for both carotid revascularization strategies.
The optimal treatment of patients presenting with either asymptomatic or symptomatic carotid artery disease (CAD) has been the topic of many debates during the last few decades. Depending on their risk profile, patients with carotid artery disease can be treated with either carotid endarterectomy (CEA), carotid artery stenting (CAS) and/or optimal medical therapy. Based on a systematic review of the available literature, Hobson et al. recently published on behalf of the Society for Vascular Surgery (SVS), evidence-based guidelines for the management of carotid artery stenosis. Although the presented guidelines contain profound valuable and valid information and considerations, it can be questioned whether the guidelines will resist time.
Abstract and Introduction
Abstract
Different approaches can be followed to allocate patients eligible for carotid revascularization to either stenting or endarterectomy. Recently, the Society for Vascular Surgery published in their clinical practice guidelines for carotid revascularization an allocation algorithm based on the patients’ surgical risk. Although the algorithm is firmly based on the available evidence from different randomized controlled trials, taking into account more recently published data on the same trials and the constant evolution in interventional techniques, it is questionable whether this conventional algorithm will resist time. An alternative algorithm allocating patients to either carotid endarterectomy or stenting is based on published high-patient and lesion profiles for suboptimal carotid artery stenting outcome. It was successfully introduced in two high-volume centers and might help in lowering the 30-day complication rates for both carotid revascularization strategies.
Introduction
The optimal treatment of patients presenting with either asymptomatic or symptomatic carotid artery disease (CAD) has been the topic of many debates during the last few decades. Depending on their risk profile, patients with carotid artery disease can be treated with either carotid endarterectomy (CEA), carotid artery stenting (CAS) and/or optimal medical therapy. Based on a systematic review of the available literature, Hobson et al. recently published on behalf of the Society for Vascular Surgery (SVS), evidence-based guidelines for the management of carotid artery stenosis. Although the presented guidelines contain profound valuable and valid information and considerations, it can be questioned whether the guidelines will resist time.
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