Extracranial Cerebrovascular Disease Clinical Practice Guidelines (SVS, 2021)

Society for Vascular Surgery

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

October 01, 2021

Guidelines for the management of extracranial cerebrovascular disease were published in June 2021 by the Society for Vascular Surgery (SVS) in Journal of Vascular Surgery.[1]

Carotid endarterectomy (CEA) is recommended as first-line treatment for symptomatic low-risk surgical patients with stenosis of 50% to 99% and asymptomatic patients with stenosis of 70% to 99%.

Carotid revascularization is appropriate for symptomatic patients with recent stable stroke and greater than 50% stenosis. It should be performed as soon as the patient is neurologically stable (after 48 hours but before 14 days of symptom onset).

Screening for clinically asymptomatic carotid artery stenosis in patients without symptoms or risk factors for carotid artery disease is not recommended.

In selected asymptomatic patients at increased risk for carotid stenosis, screening for clinically asymptomatic carotid artery stenosis is suggested as long as the patients are potentially fit for and willing to consider carotid intervention upon discovery of significant stenosis.

In patients with symptomatic carotid stenosis of 50% to 99%, who require both CEA and coronary artery bypass graft (CABG), CEA before or concomitant with CABG is suggested.

For more information, go to Atherosclerotic Disease of the Carotid Artery.

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