2018 ESVS recommendations for managing patients with symptomatic carotid artery disease28
| CEA is recommended in patients reporting carotid territory symptoms <6 months and who have a 70%–99% carotid stenosis, provided the documented procedural death/stroke rate is <6%. | Class I | Level A |
| CEA should be considered in patients reporting carotid territory symptoms <6 months and who have a 50%–69% carotid stenosis, provided the documented procedural death/stroke rate is <6%. | Class IIa | Level A |
| It is recommended that most patients who have suffered carotid territory symptoms <6 months and who are aged >70 years and who have 50%–99% stenoses should be treated by CEA, rather than by CAS. | Class I | Level A |
| When revascularisation is indicated in patients who with carotid territory symptoms <6 months and who are aged <70 years, CAS may be considered an alternative to CEA, provided procedural death/stroke rates are <6%. | Class IIb | Level A |
| When revascularisation is considered appropriate in symptomatic patients with 50%–99% stenoses, it is recommended that this be performed as soon as possible, preferably within 14 days of symptom onset. | Class I | Level A |
| Patients who are to undergo revascularisation within the first 14 days after onset of symptoms should undergo CEA, rather than CAS. | Class I | Level A |
| In recently symptomatic patients with 50%–99% stenoses and anatomical and/or medical comorbidities that are considered by the multidisciplinary team to make them ‘higher-risk for CEA, CAS should be considered as an alternative to endarterectomy, provided the documented procedural death/stroke rate is <6%. | Class IIa | Level B |
The colour of the text boxes identifies the class and level of evidence.
CAS, carotid artery stenting; CEA, carotid endarterectomy; CREST, Carotid Revascularisation versus Stenting Trial; ESVS, European Society for Vascular Surgery.