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Standards of practice and reporting standards for carotid artery angioplasty and stenting
  1. Ciaran J Powers1,
  2. Joshua A Hirsch2,
  3. M Shazam Hussain3,
  4. Athos T Patsalides4,
  5. Kristine A Blackham5,
  6. Sandra Narayanan6,
  7. Seon-Kyu Lee7,
  8. Justin F Fraser8,
  9. Ketan R Bulsara9,
  10. Charles J Prestigiacomo10,
  11. Chirag D Gandhi11,
  12. Todd Abruzzo12,
  13. Huy M Do13,
  14. Philip M Meyers14,
  15. Felipe C Albuquerque15,
  16. Donald Frei16,
  17. Michael E Kelly17,
  18. G Lee Pride18,
  19. Mahesh V Jayaraman19,
  20. on behalf of the Standards and Guidelines committee of the Society of NeuroInterventional Surgery
  1. 1Department of Neurosurgery, Wexner Medical Center, Columbus, Ohio, USA
  2. 2Department of Radiology, Division of Interventional Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts, USA
  3. 3Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
  4. 4Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
  5. 5University Hospitals Department of Radiology, Case Western Reserve University, Cleveland, Ohio, USA
  6. 6Departments of Neurosurgery and Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
  7. 7Department of Radiology, The University of Chicago, Chicago, Illinois, USA
  8. 8Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
  9. 9Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
  10. 10Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA
  11. 11Neurological Institute of New Jersey, New Jersey Medical School, Newark, New Jersey, USA
  12. 12Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
  13. 13Departments of Radiology and Neurosurgery, Stanford University Medical Center, Stanford, California, USA
  14. 14Departments of Radiology and Neurological Surgery, Columbia University, New York, New York, USA
  15. 15Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA
  16. 16Department of Interventional Neuroradiology, Radiology Imaging Associates, Englewood, Colorado, USA
  17. 17Department of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada
  18. 18Department of Neuroradiology, UT Southwestern, Dallas, Texas, USA
  19. 19Warren Alpert School of Medical at Brown University, Providence, Rhode Island, USA
  1. Correspondence to Dr Mahesh V Jayaraman, Warren Alpert School of Medical at Brown University, 593 Eddy St, Room 377, Providence, RI 2903, USA; MJayaraman{at}

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Every year almost 800 000 people in the USA suffer a new or recurrent stroke, and stroke is the third leading cause of death with over 140 000 deaths in the USA in 1995.1 Additionally, stroke is a leading cause of long-term disability with an estimated cost of $68.9 billion in 2009. The relationship between carotid artery disease and stroke was first described by Fisher in 1951,2 and it is estimated that about one-third of ischemic strokes are due to carotid artery thromboembolic disease.3 ,4

Several trials have established carotid endarterectomy (CEA) as an excellent surgical technique for revascularization and prevention of future stroke, with a reasonable safety profile. Over the last 10–15 years, carotid artery stenting has been studied as an alternative and potentially less invasive revascularization method. Early trials of carotid artery stenting struggled with high complication rates but, as experience has grown and techniques improved, more recent trials have shown complication rates comparable to CEA.

The goals of this document are to suggest standards of practice for patients treated with carotid artery angioplasty and stenting (CAS) and to provide a reporting framework for series of patients treated with CAS. Our evidence-based treatment recommendations were assessed according to criteria published by the American Heart Association/American Stroke Association (AHA/ASA) and the University of Oxford's Center for Evidence Based Medicine (CEBM). The development of treatment guidelines for CAS is facilitated by several large clinical trials that have already investigated surgical treatment for extracranial carotid stenosis as well as trials that have compared CAS with the established surgical treatment (CEA). In addition to this standards document, we would also recommend previously published guidelines for the use of CAS.5 Note that this document is not addressing the use of angioplasty with or without stenting in the setting of acute ischemic …

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  • Correction notice This article has been corrected since it was published Online First. The author Joshua A Hirsch has been added to the author list and the affiliations updated.

  • Competing interests None.

  • Provenance and peer review Not commissioned; internally peer reviewed.