Comparison of Recent Practice Guidelines for the Management of Patients With Asymptomatic Carotid Stenosis

Kosmas I. Paraskevas, Dimitri P. Mikhailidis, Pier Luigi Antignani, Enrico Ascher, Hediyeh Baradaran, Reinoud P.H. Bokkers, Richard P. Cambria, Anthony J. Comerota, Alan Dardik, Alun H. Davies, Hans Henning Eckstein, Gianluca Faggioli, Jose Fernandes e Fernandes, Gustav Fraedrich, George Geroulakos, Peter Gloviczki, Jonathan Golledge, Ajay Gupta, Mateja K. Jezovnik, Stavros K. KakkosNiki Katsiki, Michael Knoflach, M. Eline Kooi, Gaetano Lanza, George S. Lavenson, Christos D. Liapis, Ian M. Loftus, Armando Mansilha, Antoine Millon, Andrew N. Nicolaides, Rodolfo Pini, Pavel Poredos, Robert M. Proczka, Jean Baptiste Ricco, Thomas S. Riles, Peter Arthur Ringleb, Tatjana Rundek, Luca Saba, Felix Schlachetzki, Mauro Silvestrini, Francesco Spinelli, Francesco Stilo, Sherif Sultan, Jasjit S. Suri, Alexei V. Svetlikov, Clark J. Zeebregts, Seemant Chaturvedi

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Despite the publication of several national/international guidelines, the optimal management of patients with asymptomatic carotid stenosis (AsxCS) remains controversial. This article compares 3 recently released guidelines (the 2020 German–Austrian, the 2021 European Stroke Organization [ESO], and the 2021 Society for Vascular Surgery [SVS] guidelines) vs the 2017 European Society for Vascular Surgery (ESVS) guidelines regarding the optimal management of AsxCS patients. The 2017 ESVS guidelines defined specific imaging/clinical parameters that may identify patient subgroups at high future stroke risk and recommended that carotid endarterectomy (CEA) should or carotid artery stenting (CAS) may be considered for these individuals. The 2020 German–Austrian guidelines provided similar recommendations with the 2017 ESVS Guidelines. The 2021 ESO Guidelines also recommended CEA for AsxCS patients at high risk for stroke on best medical treatment (BMT), but recommended against routine use of CAS in these patients. Finally, the SVS guidelines provided a strong recommendation for CEA+BMT vs BMT alone for low-surgical risk patients with >70% AsxCS. Thus, the ESVS, German–Austrian, and ESO guidelines concurred that all AsxCS patients should receive risk factor modification and BMT, but CEA should or CAS may also be considered for certain AsxCS patient subgroups at high risk for future ipsilateral ischemic stroke.

Original languageEnglish
Pages (from-to)903-910
Number of pages8
Issue number10
StatePublished - Nov 2022
Externally publishedYes


  • asymptomatic carotid stenosis
  • best medical treatment
  • carotid artery stenting
  • carotid endarterectomy
  • guidelines
  • stroke


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