TY - JOUR
T1 - An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis
AU - Paraskevas, Kosmas I.
AU - Mikhailidis, Dimitri P.
AU - Ringleb, Peter Arthur
AU - Brown, Martin M.
AU - Dardik, Alan
AU - Poredos, Pavel
AU - Gray, William A.
AU - Nicolaides, Andrew N.
AU - Lal, Brajesh K.
AU - Mansilha, Armando
AU - Antignani, Pier Luigi
AU - de Borst, Gert J.
AU - Cambria, Richard P.
AU - Loftus, Ian M.
AU - Lavie, Carl J.
AU - Blinc, Ales
AU - Lyden, Sean P.
AU - Matsumura, Jon S.
AU - Jezovnik, Mateja K.
AU - Bacharach, J. Michael
AU - Meschia, James F.
AU - Clair, Daniel G.
AU - Zeebregts, Clark J.
AU - Lanza, Gaetano
AU - Capoccia, Laura
AU - Spinelli, Francesco
AU - Liapis, Christos D.
AU - Jawien, Arkadiusz
AU - Parikh, Sahil A.
AU - Svetlikov, Alexei
AU - Menyhei, Gabor
AU - Davies, Alun H.
AU - Musialek, Piotr
AU - Roubin, Gary
AU - Stilo, Francesco
AU - Sultan, Sherif
AU - Proczka, Robert M.
AU - Faggioli, Gianluca
AU - Geroulakos, George
AU - Fernandes e Fernandes, Jose
AU - Ricco, Jean Baptiste
AU - Saba, Luca
AU - Secemsky, Eric A.
AU - Pini, Rodolfo
AU - Myrcha, Piotr
AU - Rundek, Tatjana
AU - Martinelli, Ombretta
AU - Kakkos, Stavros K.
AU - Sachar, Ravish
AU - Goudot, Guillaume
N1 - Publisher Copyright:
© 2023 Society for Vascular Surgery
PY - 2024/2
Y1 - 2024/2
N2 - Objective: Despite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear. Methods: Fourteen controversial topics were identified. A three-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was resent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response. Results: Most experts agreed that: (1) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6% to 4% in patients with SxCS and from 3% to 2% in patients with AsxCS; (2) the time threshold for a patient being considered “recently symptomatic” should be reduced from the current definition of “6 months” to 3 months or less; (3) 80% to 99% AsxCS carries a higher risk of stroke compared with 60% to 79% AsxCS; (4) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (eg, plaque features of vulnerability and silent infarctions on brain computed tomography scans); and (5) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence. Conclusions: The present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research.
AB - Objective: Despite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear. Methods: Fourteen controversial topics were identified. A three-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was resent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response. Results: Most experts agreed that: (1) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6% to 4% in patients with SxCS and from 3% to 2% in patients with AsxCS; (2) the time threshold for a patient being considered “recently symptomatic” should be reduced from the current definition of “6 months” to 3 months or less; (3) 80% to 99% AsxCS carries a higher risk of stroke compared with 60% to 79% AsxCS; (4) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (eg, plaque features of vulnerability and silent infarctions on brain computed tomography scans); and (5) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence. Conclusions: The present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research.
KW - Asymptomatic carotid stenosis
KW - Delphi Consensus
KW - Stroke
KW - Symptomatic carotid stenosis
KW - Transient ischemic attack
UR - http://www.scopus.com/inward/record.url?scp=85179033516&partnerID=8YFLogxK
U2 - 10.1016/j.jvs.2023.09.031
DO - 10.1016/j.jvs.2023.09.031
M3 - Review article
C2 - 37944771
AN - SCOPUS:85179033516
SN - 0741-5214
VL - 79
SP - 420-435.e1
JO - Journal of Vascular Surgery
JF - Journal of Vascular Surgery
IS - 2
ER -