The Society for Vascular Surgery Releases Clinical Practice Guidelines and Implementation Document on the Management of Extracranial Cerebrovascular Disease

Rosemont, Ill., July 1, 2021 – 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.  Since stroke prevention related to carotid artery disease is of major interest to vascular surgeons, the documents aim to use the existing clinical evidence to ensure patients with atherosclerotic occlusive disease in the carotid arteries receive appropriate treatment and care.

The clinical significance of carotid artery stenosis is mainly related to its prevalence and its potential to cause stroke, defined as partial or global loss of brain neurologic function from blood supply interruption, or transient ischemic attacks (TIA), defined in a similar manner but with symptom resolution in less than 24 hours. Vascular surgeons offer all therapeutic options for carotid artery disease, including medical therapy optimization, surgical removal of carotid plaque in carotid endarterectomy (CEA) procedures, or endovascular treatment with carotid artery stenting (CAS). Extensive research has resulted in the development of evidence to guide treating physicians towards the appropriate type and timing of intervention depending on the degree of carotid disease, the presence of neurological symptoms, and the patient’s comorbidities. 

Since publication of the SVS’s previous update of the clinical practice guidelines for carotid artery disease in 2011, several pivotal studies comparing CEA and 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 provides graded recommendations that address five very relevant questions: the role of surgical therapy over medical therapy alone in asymptomatic low risk patients, the role of CEA vs. 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 Dr. Ali AbuRahma, 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, carotid endarterectomy.”

The writing group, composed of experts in carotid artery disease, also identified additional topics that needed to be addressed in more detail. These topics are addressed in a separate implementation document also published in the Journal of Vascular Surgery (JVS). This companion document includes details about 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 Dr. AbuRahma.

These clinical practice guidelines provide much needed guidance to vascular surgeons/vascular interventionalists who treat patients with extracranial cerebrovascular disease. The ultimate treatment goal should be to decrease the incidence of disabling stroke from this condition. 

Read the new guidelines here and read the implementation document here.

About the Society for Vascular Surgery

The Society for Vascular Surgery is the leading not-for-profit, professional medical society on establishing causes and treatments for vascular disease. SVS seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness and is composed of specialty-trained vascular surgeons who are dedicated to providing comprehensive care for vascular disease. For more information visit www.vascular.org. Follow the SVS on Facebook @VascularHealth, Twitter @VascularSVS and Instagram @societyforvascularsurgery.