An International, Expert-based, Multispecialty Delphi Consensus Document on Stroke Risk Stratification and the Optimal Management of Patients with Asymptomatic and Symptomatic Carotid Stenosis
| Title: | An International, Expert-based, Multispecialty Delphi Consensus Document on Stroke Risk Stratification and the Optimal Management of Patients with Asymptomatic and Symptomatic Carotid Stenosis |
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| Authors: | Kosmas I Paraskevas; Ali F AbuRahma; Wesley S Moore; Peter Gloviczki; Bruce A Perler; Daniel G Clair; Christopher J White; Carlo Setacci; Eric A Secemsky; Peter A Schneider; Clark JAM Zeebregts; Armando Mansilha; Luca Saba; Ian M Loftus; Jeffrey Jim; Christos D Liapis; Vincenzo Di Lazzaro; Alan Dardik; Pavel Poredos; Ankur Thapar; Salvatore T Scali; Mario D’Oria; Ales Blinc; Alexei Svetlikov; David H Stone; Sherif AH Sultan; Deniz Bulja; Michael C Stoner; Piotr Myrcha; Maarten Uyttenboogaart; Mark A Farber; Gianluca Faggioli; Domenica Crupi; Csaba Csobay-Novak; Jens Eldrup-Jorgensen; Gaetano Lanza; Gert J de Borst; Francesco Stilo; Meghan Dermody; Mauro Silvestrini; Christopher J Abularrage; Guillaume Goudot; Robert M Proczka; Gary S Roubin; Francesco Spinelli; Gabor Menyhei; Saeid H Shahidi; Jose Ignacio Leal Lorenzo; Arkadiusz Jawien; Tilman Reiff; Laura Capoccia; José Fernandes e Fernandes; Piotr Musiałek; Victor S Gurevich; Matthew Blecha; Caitlin W Hicks; Young M Erben; Mark F Conrad; Mahmoud B Malas; Sean P Lyden; Seemant Chaturvedi; Marc L Schermerhorn; Andrew N Nicolaides |
| Publication Year: | 2025 |
| Collection: | Anglia Ruskin University: Figshare |
| Subject Terms: | Health sciences; Best Medical Therapy; TransCarotid Artery Revascularization; asymptomatic carotid stenosis; carotid artery stenting; carotid endarterectomy; stroke risk; symptomatic carotid stenosis; 11 Medical and Health Sciences; Cardiovascular System & Hematology; 3201 Cardiovascular medicine and haematology; 3202 Clinical sciences |
| Description: | OBJECTIVE: The optimal management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis is controversial and includes intensive medical management (i.e., best medical therapy [BMT]) with/without an additional carotid revascularization procedure (i.e., carotid endarterectomy [CEA], transfemoral carotid artery stenting [TFCAS] or TransCarotid Artery Revascularization [TCAR]). The aim of this international, expert-based, multispecialty Delphi Consensus document was to reconcile the conflicting views regarding the optimal management of AsxCS and SxCS patients. METHODS: A three-round Delphi Consensus process was performed including 63 experts from Europe (n=37) and the United States (n=26). A total of 6 different clinical scenarios were identified involving patients with either AsxCS or SxCS. For each scenario, 5 treatment options were available: (i) BMT alone, (ii) BMT plus CEA, (iii) BMT plus TFCAS, (iv) BMT plus TCAR, or (v) BMT plus CEA/TFCAS/TCAR. Differences in treatment preferences between U.S. and European participants were assessed using Fisher's Exact Test, and odds ratios were used to quantify the magnitude and direction of association. Consensus was achieved when >70% of the Delphi Consensus participants agreed on a therapeutic approach. RESULTS: Most participants concurred that BMT alone is not adequate for the management of a 70-year-old fit male or female patient with 80-99% AsxCS (52/63; 82.5% and 45/63; 71.5%, respectively). In contrast, most panelists would opt for BMT alone for an 80-year-old male AsxCS patient with several co-morbidities (48/63; 76.2%). The majority of participants would opt for BMT plus a carotid revascularization procedure for an 80-year-old male SxCS patient with a recent ipsilateral cerebrovascular event, an ipsilateral 70-99% SxCS and a 5-year predicted risk of ipsilateral ischemic event of 10% (54/63; 85.7%), 15% (59/63; 93.6%), or 20% (63/63; 100%). The opinion of U.S.-based participants varied from that of Europe-based respondents in some ... |
| Document Type: | article in journal/newspaper |
| Language: | unknown |
| Relation: | 10779/aru.30385117.v1 |
| Availability: | https://figshare.com/articles/journal_contribution/An_International_Expert-based_Multispecialty_Delphi_Consensus_Document_on_Stroke_Risk_Stratification_and_the_Optimal_Management_of_Patients_with_Asymptomatic_and_Symptomatic_Carotid_Stenosis/30385117 |
| Rights: | CC BY-NC-ND 4.0 |
| Accession Number: | edsbas.F824FD72 |
| Database: | BASE |