{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T19:25:17Z","timestamp":1793993117630,"version":"4.8.0"},"reference-count":114,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"11","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[2015,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Purpose\u2014<\/jats:title>\n                    <jats:p>We systematically compared and appraised contemporary guidelines on management of asymptomatic and symptomatic carotid artery stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods\u2014<\/jats:title>\n                    <jats:p>We systematically searched for guideline recommendations on carotid endarterectomy (CEA) or carotid angioplasty\/stenting (CAS) published in any language between January 1, 2008, and January 28, 2015. Only the latest guideline per writing group was selected. Each guideline was analyzed independently by 2 to 6 authors to determine clinical scenarios covered, recommendations given, and scientific evidence used.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results\u2014<\/jats:title>\n                    <jats:p>Thirty-four eligible guidelines were identified from 23 different regions\/countries in 6 languages. Of 28 guidelines with asymptomatic carotid artery stenosis procedural recommendations, 24 (86%) endorsed CEA (recommended it should or may be provided) for \u224850% to 99% average-surgical-risk asymptomatic carotid artery stenosis, 17 (61%) endorsed CAS, 8 (29%) opposed CAS, and 1 (4%) endorsed medical treatment alone. For asymptomatic carotid artery stenosis patients considered high-CEA-risk because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 13 guidelines (46%). Thirty-one of 33 guidelines (94%) with symptomatic carotid artery stenosis procedural recommendations endorsed CEA for patients with \u224850% to 99% average-CEA-risk symptomatic carotid artery stenosis, 19 (58%) endorsed CAS and 9 (27%) opposed CAS. For high-CEA-risk symptomatic carotid artery stenosis because of comorbidities, vascular anatomy, or undefined reasons, CAS was endorsed in 27 guidelines (82%). Guideline procedural recommendations were based only on results of trials in which patients were randomized 12 to 34 years ago, rarely reflected medical treatment improvements and often understated potential CAS hazards. Qualifying terminology summarizing recommendations or evidence lacked standardization, impeding guideline interpretation, and comparison.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\u2014<\/jats:title>\n                    <jats:p>This systematic review has identified many opportunities to modernize and otherwise improve carotid stenosis management guidelines.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/strokeaha.115.003390","type":"journal-article","created":{"date-parts":[[2015,10,8]],"date-time":"2015-10-08T23:23:57Z","timestamp":1444346637000},"page":"3288-3301","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":251,"title":["Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis"],"prefix":"10.1161","volume":"46","author":[{"given":"Anne L.","family":"Abbott","sequence":"first","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kosmas I.","family":"Paraskevas","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stavros K.","family":"Kakkos","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Golledge","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans-Henning","family":"Eckstein","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry J.","family":"Diaz-Sandoval","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longxing","family":"Cao","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Fu","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tissa","family":"Wijeratne","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas W.","family":"Leung","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel","family":"Montero-Baker","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Byung-Chul","family":"Lee","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Pircher","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marije","family":"Bosch","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martine","family":"Dennekamp","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Ringleb","sequence":"additional","affiliation":[{"name":"From the Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine (A.L.A, M.D.), Department of Surgery, Central Clinical School (M.B.), Monash University, Melbourne, Victoria, Australia; Neurology Department, The Alfred Hospital, Prahran, Victoria, Australia (A.L.A.); Department of Cardiovascular Sciences, St. George\u2019sVascular Institute, St George\u2019s Hospital, London, United Kingdom (K.I.P.); Department of Vascular Surgery, University of Patras, Patras,..."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-4949.2007.00096.x"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.109.556068"},{"key":"e_1_3_4_4_2","unstructured":"Abbott AL. Stroke rates associated with asymptomatic carotid stenosis and medical treatment alone continue to fall: Results of an updated meta-analysis (late breaking science abstract presented at the AHA International Stroke Conference 2013). American Heart Association Web site. http:\/\/my.americanheart.org\/idc\/groups\/ahamah-public\/@wcm\/@sop\/@scon\/documents\/downloadable\/ucm_448656.pdf. Accessed August 11 2015."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2009.01.026"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2011.151"},{"key":"e_1_3_4_7_2","unstructured":"Raman G Kitsios GD Moorthy D Hadar N Dahabreh IJ O\u2019Donnell TF et al.. Management of asymptomatic carotid stenosis: Technology Assessment Report. Tufts Evidence-based Practice Center: Project ID: CRDT0510. 2012:83. U.S. Department of Health & Human Services Web site. http:\/\/www.ahrq.gov\/research\/findings\/ta\/carotidstenosis\/carotidstenosis.pdf. 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