2018 ESVS recommendations for managing patients with asymptomatic carotid artery disease28
| In ‘average surgical risk’ patients with an asymptomatic 60%–99% stenosis, CEA should be considered in the presence of 1+ imaging characteristics that may be associated with an increased risk of late ipsilateral stroke*, provided perioperative stroke/death rates are <3% and the patient’s life expectancy exceeds 5 years. | Class IIa | Level B |
| In ‘average surgical risk’ patients with an asymptomatic 60%–99% stenosis in the presence of 1+ imaging characteristics that may be associated with an increased risk of late ipsilateral stroke*, CAS may be an alternative to CEA, provided perioperative stroke/death rates are <3% and the patient’s life expectancy exceeds 5 years. | Class IIb | Level B |
| CAS may be considered in selected asymptomatic patients who have been deemed by the multidisciplinary team to be ‘high-risk for CEA’ and who have an asymptomatic 60%–99% stenosis in the presence of 1+ imaging characteristics that may be associated with an increased risk of late ipsilateral stroke*, provided procedural risks are <3% and the patient’s life expectancy exceeds 5 years. | Class IIb | Level B |
*See table 5 for clinical/imaging features.
The colour of the text boxes identifies the class and level of evidence.
CAS, carotid artery stenting; CEA, carotid endarterectomy; ESVS, European Society for Vascular Surgery.