ACCF/SCAI/SVMB/SIR/ASITN 2007 Clinical Expert Consensus Document on Carotid Stenting A Report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents (ACCF/SCAI/SVMB/SIR/ASITN Clinical Expert Consensus Document Committee on Carotid Stenting) Developed in Collaboration With the American Society of Interventional & Therapeutic Neuroradiology, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society of Interventional Radiology Carotid Endarterectomy (CEA) Current AHA guidelines recommend CEA in symptomatic patients with stenosis 50% to 99%, if the risk of perioperative stroke or death is less than 6%. For asymptomatic patients, AHA guidelines recommend CEA for stenosis 60% to 99%, if the risk of perioperative stroke or death is less than 3%. The 2005 guidelines from the American Academy of Neurology recommend that eligible patients should be 40 to 75 years old and have a life expectancy of at least 5 years. Carotid Stenting Carotid artery stenting is a reasonable alternative to CEA, particularly in patients at high risk for CEA. Although there are no randomized studies comparing CAS with and without embolic protection devices (EPDs), the use of EPDs appears to be important in reducing the risk of stroke during CAS. Careful neurological assessment is required before and after CAS. The Centers for Medicare & Medicaid Services (CMS) reimbursement is limited to qualified institutions and physicians when using Food and Drug Administration (FDA)-approved stents and EPDs for high-risk patients with symptomatic stenosis greater than 70%, and for high-risk patients (symptomatic stenosis greater than 50%, asymptomatic stenosis greater than 80%) enrolled in a Category B Investigational Device Exemption (IDE) trial or post-approval study. At the present time, there is insufficient evidence to support CAS in high-risk patients with asymptomatic stenosis less than 80% or in any patient without high-risk features. The results of ongoing randomized trials will define the future role of CAS in low-risk patients. Further study is needed in asymptomatic high-risk patients to determine the relative merits of CAS compared with best medical therapy.
_________________ Букина Оксана Васильевна
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