The European Society for Vascular Surgery Guidelines for Carotid Intervention: An Updated Independent Assessment and Literature Review

Kakisis, John D.; Avgerinos, Efthimios D.; Antonopoulos, Constantine N.; Giannakopoulos, Triantafillos G.; Moulakakis, K.G.; Liapis, Christos D.

doi:10.1016/j.ejvs.2012.04.015

Cited by 70 publications

(56 citation statements)

References 42 publications

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“…On the contrary, the American Society for Vascular Surgery [24] published an update of their 2008 guidelines 2 months after the publication of AHA guidelines stating that their guidelines were more circumspect with regard to the role of CAS and a more supportive role of CEA. Kakisis et al [25] reviewed the 2009 European Society for Vascular Surgery guidelines and also found that CEA is preferable to CAS for the majority of symptomatic patients. However, both guidelines of the vascular societies did not recommend CAS for asymptomatic patients.…”

Section: Randomized Trials Of Cea Vs Casmentioning

confidence: 99%

“…According to the latest guidelines [2,24,25] , BMT is an essential part of the treatment for all patients with CS whereas symptomatic patients with more than 50% stenosis and highly selected patients with more than 60% asymptomatic stenosis should be considered for CR. In spite of disputable data from CAS and CEA, each of them is associated with their own high-risk features, which are summarized in table 3 .…”

Section: Decision-making On Management Of Carotid Stenosismentioning

confidence: 99%

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Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting

Noiphithak

Liengudom²

2016

Cerebrovasc Dis

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Carotid artery stenosis (CS) is a major cause of ischemic stroke. Treatment of CS consists of best medical treatment and carotid revascularization (CR), including carotid endarterectomy (CEA) and carotid artery stenting (CAS). Both CR techniques have their own procedural risks. Therefore, selection of the appropriate treatment for patients with CS is relatively complicated. Many studies and guidelines have reported the efficacy of each treatment for both symptomatic and asymptomatic patients. However, the results are still controversial, especially concerning the efficacy and safety of CEA and CAS. In this paper, we review and discuss the current evidence and compare results from studies of CEA and CAS, including major randomized trials, meta-analyses and ongoing trials. Moreover, based on the current data, we propose a new comprehensive decision-making for the management of CS.

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Section: Randomized Trials Of Cea Vs Casmentioning

confidence: 99%

Section: Decision-making On Management Of Carotid Stenosismentioning

confidence: 99%

Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting

Noiphithak

Liengudom²

2016

Cerebrovasc Dis

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“…Higher volume hospitals may have more vascular surgeons with a particular interest in carotid surgery as well as specialist anesthetists and better short-term results [13] . Currently, European and US guidelines do not specify a minimum volume or experience for CEA practice [14,15] . The present report does not demonstrate significantly lower complication rates amongst centers with more experienced surgeons.…”

Section: Discussionmentioning

confidence: 99%

Clinical Experience amongst Surgeons in the Asymptomatic Carotid Surgery Trial-1

Huibers

Waard²,

Borst³

et al. 2016

Cerebrovasc Dis

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Introduction: Hospital volume may influence the outcomes of carotid revascularization, but in trials the effect of the clinical experience of individual surgeons on procedural outcome is less certain. We assessed perioperative event rates amongst centers with different trial entry volumes and also the effects of individual operator experience in the first Asymptomatic Carotid Surgery Trial-1 (ACST-1). Methods: In 126 centers participating in ACST-1, surgeons were classified according to their in-trial experience (group A: 50 cases; group B: 51-100 cases; group C: >100 cases), center enrolment volume (group I: <30 patients; group II: 30-75 patients; group III: >75 patients) and center annual hospital volume (group 1: <40 carotid endarterectomies (CEAs); group 2: 40-75 CEAs; group 3: >75 cases). Differences in perioperative event rates were compared using logistic regression analysis. Results: In centers with the most clinical experience compared with those with least experience (groups C vs. A), the number of strokes or deaths was 8 of 275 (2.9%) versus 24 of 810 (3.0%) with OR 0.99 (95% CI 0.44-2.25, p = 0.986). Numbers of strokes or death in high enrolment centers compared with those in low enrolment centers (groups III vs. I) was 20 of 680 (2.9%) versus 21 of 580 (3.6%) with OR 0.81 (95% CI 0.43-1.51, p = 0.921). In centers with a high annual volume compared with those of low annual volume (groups 3 vs. 1), numbers of strokes and death were non-significantly lower, 26 of 823 (3.2%) versus 19 of 422 (4.5%) with OR 0.68 (95% CI 0.37-1.26, p = 0.386). Cumulative stroke risk at 5 and 10 years were similar among different levels of reported clinical experience, enrolment volume and annual hospital volume. Conclusion: Although our data did not demonstrate an association between perioperative complications and operators' experience, enrolment volume or annual hospital volume, rates of stroke or death were numerically lower in both high enrolment and high annual volume centers. This lack of association could be explained by an overall low procedural risk in ACST-1.

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“…One in five patients suffer from ischemic stroke caused by internal carotid artery stenosis (1). The available level I evidence recommends surgery as currently the best option for symptomatic patients (2).…”

Section: Introductionmentioning

confidence: 99%

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

Kontrimavičiūtė¹,

Kuzminskaitė²,

Šipylaitė³

2015

AML

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Background. Cerebral monitoring during carotid endarterectomy allows to detect brain hypoperfusion following carotid clamping and hyperperfusion after restoring the blood flow. Immediate corrections of these changes have the potential in reducing adverse neurologic outcomes. In this study we share our experience using cerebral oximetry in carotid endarterectomy surgery, as well as finding a connection between comorbidities and baseline cerebral oxygenation values.Materials and methods. A non-randomised perspective study was performed at Vilnius University Hospital Santariškių Clinics. During 2012-2013 all consecutive elective patients undergoing carotid surgery were enrolled in the study.Results. No difference was found in the baseline values on the operative and control sides (71.15% vs 76.76%, p = 0.15). After carotid clamping regional brain saturation decreased by 4.34% of the baseline on the operative side. During the clamping cerebral oxygenation was lower on the operative side (68.06% vs 77.32%, p = 0.03). Following carotid declamping the difference between operative and control side oxygenation diminished (73.57% vs 79.30%, p = 0.16). Neither diabetes nor peripheral atherosclerosis had influence on baseline cerebral oxygen saturation values. There was a tendency towards the lower cerebral oxygenation baseline for smokers (70.12% vs 76.54%, p = 0.103).Conclusions. Cerebral oximetry is a valuable method of cerebral monitoring reflecting changes in brain perfusion during carotid endarterectomy. Certain comorbidities might have a role in affecting baseline oximetry values.

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The European Society for Vascular Surgery Guidelines for Carotid Intervention: An Updated Independent Assessment and Literature Review

Cited by 70 publications

References 42 publications

Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting

Recent Update on Carotid Endarterectomy versus Carotid Artery Stenting

Clinical Experience amongst Surgeons in the Asymptomatic Carotid Surgery Trial-1

Noninvasive cerebral oximetry during carotid endarterectomy: application and results

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