Standards of practice and reporting standards for carotid artery angioplasty and stenting

Every year almost 800 000 people in the USA suffer a new or recurrent stroke, and stroke is the third leading cause of death with over 140 000 deaths in the USA in 1995.1 Additionally, stroke is a leading cause of long-term disability with an estimated cost of $68.9 billion in 2009. The relationship between carotid artery disease and stroke was first described by Fisher in 1951,2 and it is estimated that about one-third of ischemic strokes are due to carotid artery thromboembolic disease.3 ,4 Several trials have established carotid endarterectomy (CEA) as an excellent surgical technique for revascularization and prevention of future stroke, with a reasonable safety profile. Over the last 10–15 years, carotid artery stenting has been studied as an alternative and potentially less invasive revascularization method. Early trials of carotid artery stenting struggled with high complication rates but, as experience has grown and techniques improved, more recent trials have shown complication rates comparable to CEA. The goals of this document are to suggest standards of practice for patients treated with carotid artery angioplasty and stenting (CAS) and to provide a reporting framework for series of patients treated with CAS. Our evidence-based treatment recommendations were assessed according to criteria published by the American Heart Association/American Stroke Association (AHA/ASA) and the University of Oxford's Center for Evidence Based Medicine (CEBM). The development of treatment guidelines for CAS is facilitated by several large clinical trials that have already investigated surgical treatment for extracranial carotid stenosis as well as trials that have compared CAS with the established surgical treatment (CEA). In addition to this standards document, we would also recommend previously published guidelines for the use of CAS.5 Note that this document is not addressing the use of angioplasty with or without stenting in the setting of acute ischemic …