[Current guidelines on carotid artery stenting. Critical evaluation].

Area of Science:

• Cardiovascular Medicine
• Interventional Neurology
• Evidence-Based Medicine

Background:

• Current guidelines for carotid artery stenosis treatment are based on interdisciplinary discussions and selective interpretation of European studies.
• Conflicting recommendations exist, particularly when comparing surgical interventions with carotid artery stenting (CAS).

Purpose of the Study:

• To highlight the discrepancies in current guidelines regarding carotid artery stenosis treatment.
• To identify the challenges in conducting new comparative studies for carotid artery disease therapy.

Main Methods:

• Analysis of existing European randomized studies and current international guidelines (ESC, American guidelines, German Society of Cardiology comments).
• Discussion of the limitations in evidence-based medicine and the difficulties in designing new, large-scale randomized trials.

Main Results:

• Surgical guidelines suggest CAS only for specific symptomatic patients with disadvantages or comorbidities.
• ESC guidelines recommend CAS for high-risk patients if outcomes match surgery, while American guidelines equate CAS and carotid endarterectomy (CEA) assuming similar complication rates.
• Differential data interpretation leads to varied recommendations, with a lack of definitive comparative studies.

Conclusions:

• The optimal treatment for carotid artery disease remains unclear due to inadequate data and conflicting interpretations.
• Challenges in funding, patient recruitment, and the rapid evolution of techniques hinder the development of new, conclusive randomized trials.