Carotid artery stenting: first consensus document of the ICCS-SPREAD Joint Committee
Alberto Cremonesi1, Carlo Setacci, Angelo Bignamini
1Società Italiana di Cardiologia Interventistica (Italian Society of Interventional Cardiology).
Insights
This consensus document provides evidence-based guidance on carotid artery stenting for severe carotid stenosis. It details indications, procedures, and physician qualifications for this less invasive stroke prevention technique.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Vascular Surgery
Background:
- Carotid artery stenosis management is a key debate in cardiovascular medicine.
- Carotid angioplasty and stenting (CAS) offers a less invasive alternative to carotid endarterectomy for severe carotid obstructive disease, especially in patients with comorbidities.
Framework:
- This consensus document, developed by the Italian Consensus Carotid Stenting (ICCS)/SPREAD group, offers evidence-based recommendations.
- It addresses critical aspects including methodology, stenosis classification (symptomatic vs. asymptomatic), and CAS procedures.
Implementation:
- The document emphasizes the use of embolic protection devices during CAS procedures.
- It also focuses on physician qualifications, including training, acceptable complication rates, and certification for performing vascular angioplasty and stent placement.
Implications:
- This consensus aims to guide neurologists, radiologists, cardiologists, and vascular surgeons in the prevention and treatment of carotid disease.
- It underscores the need for continuous updates and discussion in the rapidly evolving field of carotid stenosis management.
Background And Purpose:
The prevention of stroke and the correct treatment of carotid artery stenosis represent today a major debate in cardiovascular medicine. Beside carotid endarterectomy, carotid angioplasty and stenting is becoming more widely performed for the treatment of severe carotid obstructive disease, and is now accepted as a less invasive technique that may provide an alternative for selected patients, particularly those with significant comorbidities. An Italian multidisciplinary task force, in which converged the most representative scientific societies involved in carotid treatment, was created to provide neurologists, radiologist, cardiologists, vascular surgeons, and all those involved in prevention and treatment of carotid disease with a simple, clear and updated evidence-based consensus document.
Summary Of Review:
This First Consensus Document of the ICCS (Italian Consensus Carotid Stenting)/SPREAD group addressed the main issues related to methodology, definition of symptomatic and asymptomatic carotid stenosis, indication and procedures for carotid artery stenting, including the use of devices for preventing procedural embolic complications. Special attention was paid to credentials and competency for physicians qualifications to perform vascular angioplasty and stent placement, including training, acceptable complication rates and certification.
Conclusions:
As any guideline or consensus statement, also this document is valid as long as the evidence on which it is based remains up-to-date. In such a fast-evolving field of medicine as the management of carotid stenosis, it is mandatory to stimulate a continuous and fruitful discussion among all the professionals involved in this very evolutionary field.
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