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2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary

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  • This article is a reprint of the paper that first appeared in the Journal of the American College of Cariology 2011;57:1002–44, doi:10.1016/j.jacc.2010.11.005. Copyright by and reprinted with permission from the American College of Cardiology Foundation and the American Heart Association Inc.

  • * Authors with no number by their name were included to provide additional content expertise apart from organizational representation.

  • Additional informations about the article are listed in the appendix.

  • Thomas G Brott and Jonathan L Halperin are Co-Chairs.

  • Provenance and peer review Not commissioned; not externally peer reviewed.

  • i Recommendations for revascularization in this section assume that operators are experienced, having successfully performed the procedures in >20 cases with proper technique and a low complication rate based on independent neurological evaluation before and after each procedure.

  • ii Non-disabling stroke is defined by a residual deficit associated with a score ≤2 according to the modified Rankin Scale.

  • iii The degree of stenosis is based on catheter based or non-invasive vascular imaging compared with the distal arterial lumen or velocity measurements by duplex ultrasonography. (See section 7 text in the full text version of the guideline for details.)

  • iv Conditions that produce unfavorable neck anatomy include, but are not limited to, arterial stenosis distal to the second cervical vertebra or proximal (intrathoracic) arterial stenosis, previous ipsilateral CEA, contralateral vocal cord paralysis, open tracheostomy, radical surgery and irradiation.

  • v Comorbidities that increase the risk of revascularization include, but are not limited to, age >80 years, New York Heart Association class III or IV heart failure, left ventricular ejection fraction <30%, class III or IV angina pectoris, left main or multivessel coronary artery disease, need for cardiac surgery within 30 days, MI within 4 weeks and severe chronic lung disease.

  • vi In this context, severe disability refers generally to a modified Rankin Scale of ≥3, but individual assessment is required, and intervention may be appropriate in selected patients with considerable disability when a worse outcome is projected with continued medical therapy alone.