The Society for Vascular Surgery (SVS) has released updated clinical practice guidelines accompanied by an implementation document on the management of patients with extracranial carotid artery disease. The documents, both published in the Journal of Vascular Surgery, aim to use the existing clinical evidence to ensure patients with atherosclerotic occlusive disease in the carotid arteries receive appropriate treatment and care.
Since publication of the SVS’s previous update of the clinical practice guidelines for carotid artery disease in 2011, several pivotal studies comparing carotid endarterectomy (CEA) and carotid artery stenting (CAS) have been published. In addition, the literature has demonstrated a confirmation of the need for optimization of medical therapy. Therefore, the updated SVS guidelines provide graded recommendations that address five questions: the role of surgical therapy over medical therapy alone in asymptomatic low risk patients, the role of CEA versus CAS in symptomatic low-risk patients, the optimal timing of interventions after acute stroke, screening for carotid artery stenosis in asymptomatic patients, and the sequence of carotid and coronary interventions in patients undergoing intervention for diseases in both vascular territories.
According to Ali AbuRahma, MD, of West Virginia University, Charleston, West Virginia, chair of the writing group, “These guideline recommendations address the latest technology in the management of carotid disease, such as transcarotid artery stenting with flow reversal and how its outcomes compare to transfemoral stenting and the gold standard, CEA.”
The writing group, composed of experts in carotid artery disease, also identified additional topics that needed to be addressed more thoroughly. A separate implementation document includes details on some of these topics, including therapeutic decision-making, perioperative management, medical therapy, other cerebrovascular conditions, and practice management. It is intended to make the guidelines more practical and helpful to clinicians, and provides implementation details to facilitate adoption and operationalization of the guideline recommendations.
“The advantage of two documents is having quick access to evidence-based recommendations in the clinical practice guideline, while also having the implementation document, which comprehensively addresses every aspect of the management of carotid disease and stroke prevention,” says AbuRahma.