Current status of carotid bifurcation angioplasty and stenting based on a consensus of opinion leaders

• Published in: Journal of vascular surgery 2001-02, Vol.33 (2), p.111-116
• Main Authors: Veith, Frank J., Amor, Max, Ohki, Takao, Beebe, Hugh G., Bell, Peter R.F., Bolia, Amman, Bergeron, Patrice, Connors, John J., Diethrich, Edward B., Ferguson, Robert D.G., Henry, Michel, Hobson, Robert W., Hopkins, L.Nelson, Katzen, Barry T., Matthias, Klaus, Roubin, Gary S., Theron, Jacques, Wholey, Mark H., Yadav, Sanjay S.
• Format: Article
• Language: English
• Subjects: Angioplasty - instrumentation; Angioplasty - methods; Attitude of Health Personnel; Benchmarking; Biological and medical sciences; Carotid Artery Diseases - surgery; Clinical Competence - standards; Diffusion of Innovation; Diseases of the cardiovascular system; Evidence-Based Medicine; Humans; Medical sciences; Needs Assessment; Patient Selection; Practice Guidelines as Topic - standards; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Stents; Treatment Outcome
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1067/mva.2001.111665

Objective: Carotid bifurcation angioplasty and stenting (CBAS) has generated controversy and widely divergent opinions about its current therapeutic role. To resolve differences and establish a unified view of CBAS' present role, a consensus conference of 17 experts, world opinion leaders from five countries, was held on November 21, 1999. Methods: These 17 participants had previously answered 18 key questions on current CBAS issues. At the conference these 18 questions and participants' answers were discussed and in some cases modified to determine points of agreement (consensus), near consensus, (prevailing opinion), or divided opinion (disagreement). Results: Conference discussion added two modified questions, placing a total of 20 key questions before the participants, representing four specialties (interventional radiology, seven; vascular surgery, six; interventional cardiology, three; neurosurgery, one). It is interesting that consensus was reached on the answers to 11 (55%) of 20 of the questions, and near consensus was reached on answers to 6 (30%) of 20 of the questions. Only with the answers to three (15%) of the questions was there persisting controversy. Moreover, both these differences and areas of agreement crossed specialty lines. Consensus Conclusions: CBAS should not currently undergo widespread practice, which should await results of randomized trials. CBAS is currently appropriate treatment for patients at high risk in experienced centers. CBAS is not generally appropriate for patients at low risk. Neurorescue skills should be available if CBAS is performed. When cerebral protection devices are available, they should be used for CBAS. Adequate stents and technology for performing CBAS currently exist. There were divergent opinions regarding the proportions of patients presently acceptable for CBAS treatment (