An International, Expert-Based Delphi Consensus Document on Controversial Issues about TransCarotid Artery Revascularization (TCAR)

Data de publicação: Data Ahead of Print:

Autores da FMUP

  • Armando Amilcar Pires Mansilha Rodrigues De Almeida

    Autor

Participantes de fora da FMUP

  • Paraskevas K.I.
  • AbuRahma A.F.
  • Abularrage C.J.
  • Clair D.G.
  • Eldrup-Jorgensen J.
  • Kashyap V.S.
  • Dardik A.
  • de Borst G.J.
  • Dermody M.
  • Faggioli G.
  • Hicks C.W.
  • Kwolek C.J.
  • Lyden S.P.
  • Van Herzeele I.
  • Myrcha P.
  • Leal Lorenzo J.I.
  • Jim J.
  • Pini R.
  • Secemsky E.A.
  • Spinelli F.
  • Capoccia L.
  • Stone D.H.
  • Stoner M.C.
  • Zeebregts C.J.
  • Lal B.K.
  • Schneider P.A.
  • Malas M.B.
  • Schermerhorn M.L.

Unidades de investigação

Abstract

Background: Transcarotid artery revascularization (TCAR) has emerged as an alternative therapeutic modality to carotid endarterectomy (CEA) and transfemoral carotid artery stenting (TFCAS) for the management of patients with carotid artery stenosis. However, certain issues regarding the indications and contraindications of TCAR remain unanswered or unresolved. The aim of this international, expert-based Delphi consensus document was to attempt to provide some guidance on these topics. Methods: A 3-round Delphi consensus process was performed, including 29 experts. The aim of round 1 was to investigate the differing views and opinions of the participants. Round 2 was carried out after the results from the literature on each topic were provided to the participants. During round 3, the participants had the opportunity to finalize their vote. Results: Most participants agreed that TCAR can or can probably or possibly be performed within 14 days of a cerebrovascular event, but it is best to avoid it in the first 48 hr. It was felt that TCAR cannot or should not replace TFCAS or CEA, as each procedure has specific indications and contraindications. Symptomatic patients >80 years should probably be treated with TCAR rather than with TFCAS. TCAR can or can probably be used for the treatment of restenosis following CEA or TFCAS. Finally, there is a need for a randomized controlled trial (RCT) to provide better evidence for the unresolved issues. Conclusions: This Delphi consensus document attempted to assist the decision-making of physicians or interventionalists or vascular surgeons involved in the management of carotid stenosis patients. Furthermore, areas requiring additional research were identified. Future studies and RCTs should provide more evidence to address the unanswered questions regarding TCAR. © 2024 Elsevier Inc.

Copyright © 2024 Elsevier Inc. All rights reserved.

Dados da publicação

ISSN/ISSNe:
1615-5947, 0890-5096

Annals of Vascular Surgery  Elsevier Inc.

Tipo:
Article
Páginas:
42-53
Link para outro recurso:
www.scopus.com

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Keywords

  • aged; Article; carotid artery stenting; carotid artery surgery; carotid endarterectomy; carotid restenosis; carotid stenosis; cerebral revascularization; cerebrovascular accident; conflict of interest; consensus; controlled study; Embase; human; intermethod comparison; life expectancy; medical literature; Medline; minor stroke; Scopus; sensitivity analysis; surgical risk; transcarotid artery revascularization; transfemoral carotid artery stenting; transient ischemic attack; very elderly

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