Guidelines for the management of carotid artery stenosis: A statement from Taiwan Stroke Society guideline committee of carotid artery stenosis management

The severity of carotid artery stenosis can highly predict the occurrence of ischemic stroke. Carotid endarterectomy (CEA) has been shown to have greater benefit over medical therapy to prevent the strokes from symptomatic and asymptomatic carotid artery stenosis. Recently, carotid artery angioplasty with or without stenting (CAS) has emerged as an alternative therapy for carotid artery stenosis. The Taiwan Stroke Society revised the guidelines for management of carotid artery stenosis. Screening of carotid arteries by ultrasonography is suggested in subjects with multiple vascular risk factors, the presence of coronary artery or peripheral vascular diseases, post-radiotherapy of head and neck, and post-CEA or CAS. General population screening is not suggested. Cerebral angiography is still the standard for determination of carotid artery stenostic severity. CEA can be performed in symptomatic patients with carotid artery stenosis 70-99% and perioperative stroke and mortality rates less than 6%. CEA should not be done in patients with carotid artery stenosis greater than 50% and high surgical risks. Continuous antithrombotic agents and risk factor control post-intervention are needed. CAS can be considered if patients are unable to receive CEA, post-radiotherapy, and the presence of tandem stenosis. CEA may be performed in asymptomatic patients if the perioperative complication is less than 3%. CAS is not suggested for routine use in asymptomatic patients unless high surgical risks for CEA.