CardioExchange Archive

Newly issued guidelines provide increased support for carotid stenting as an alternative to carotid endarterectomy, but don’t favor widespread screening or the routine use of ultrasound to assess the risk for stroke. The Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease, developed by the AHA, the ACC, and multiple other organizations, is published online in Circulation, Stroke, and JACC.

Both stenting and endarterectomy are acceptable when blockages are greater than 50%, according to the guidelines, but medical therapy may be preferable for many patients. “The guidelines support carotid surgery as a tried-and-true treatment for most patients,” said Thomas G. Brott, co-chair of the writing committee, in a press release. “However, for patients who have a strong preference for less invasive treatments, carotid stenting offers a safe alternative. Because of the anatomy of their arteries or other individual considerations, some patients may be more appropriate for surgery and others for stenting.”

“The risks of these procedures have fallen considerably, but you need to make sure you have very experienced practitioners performing the latest techniques,” said Jonathan Halperin, the other co-chair.

Although widespread screening is not endorsed in the new guidelines, Halperin said that screening is reasonable in people with two or more risk factors for stroke.