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Updated: Jun 24, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques.

C D Liapis¹, P R F Bell, D Mikhailidis

¹Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece. liapis@med.uoa.gr

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery

|March 17, 2009

Summary

Updated guidelines recommend carotid endarterectomy (CEA) for symptomatic patients with >50% stenosis and select asymptomatic men. Carotid artery stenting (CAS) is reserved for high-risk patients in specialized centers.

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Last Updated: Jun 24, 2026

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Area of Science:

Vascular Surgery
Neurology
Cardiology

Background:

Carotid artery disease poses a significant risk of stroke.
Accurate and up-to-date guidelines are crucial for effective invasive treatment.
Expert consensus is needed to refine treatment strategies.

Purpose of the Study:

To provide updated guidelines for the invasive treatment of carotid artery disease.
To stratify recommendations based on evidence level.
To clarify indications for carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Main Methods:

A panel of European Society for Vascular Surgery experts convened to develop recommendations.
Recommendations were graded according to the level of evidence.
Guideline development involved reviewing current literature and clinical data.

Main Results:

Carotid endarterectomy (CEA) is recommended for symptomatic patients with >50% stenosis (perioperative risk <6%) and asymptomatic men <75 years with 70-99% stenosis (perioperative risk <3%).
CEA benefit is less in asymptomatic women, suggesting consideration only in younger, fit individuals.
Carotid patch angioplasty is preferred over primary closure; aspirin and statins are recommended peri-procedurally for CEA.

Conclusions:

Carotid endarterectomy (CEA) remains a primary treatment for specific symptomatic and asymptomatic patient groups.
Carotid artery stenting (CAS) is indicated for CEA-high-risk patients in experienced centers or clinical trials, requiring dual antiplatelet therapy.
These guidelines aim to optimize patient outcomes and reduce stroke risk through evidence-based invasive carotid interventions.