Evidence map›Paper›PMID 37944771›Full record

ReviewJournal of vascular surgery2024

An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis.

Kosmas I Paraskevas, Dimitri P Mikhailidis, Peter Arthur Ringleb, Martin M Brown, Alan Dardik, Pavel Poredos, William A Gray, Andrew N Nicolaides, Brajesh K Lal, Armando Mansilha and 51 more

Abstract readReviewConsensus Statement
PubMed Full text at PMC Publisher
In one paragraph

Review in Journal of vascular surgery, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Trial
  3. Article
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

61 authors.

Kosmas I ParaskevasDepartment of Vascular Surgery, Central Clinic of Athens, Athens, Greece. Electronic address: paraskevask@hotmail.com.
Dimitri P MikhailidisDivision of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, University College London (UCL) and Department of Clinical Biochemistry, Royal Free Hospital Campus, UCL, London, United Kingdom.
Peter Arthur RinglebDepartment of Neurology, Heidelberg University Hospital, Heidelberg, Germany.
Martin M BrownDepartment of Brain Repair and Rehabilitation, Stroke Research Centre, UCL Queen Square Institute of Neurology, University College London, London, United Kingdom.
Alan DardikDepartment of Surgery, Yale School of Medicine, New Haven, CT.
Pavel PoredosDepartment of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
William A GrayLankenau Heart Institute, Wynnewood, PA.
Andrew N NicolaidesVascular Screening and Diagnostic Center, Nicosia, Cyprus; University of Nicosia Medical School, Nicosia, Cyprus; Department of Vascular Surgery, Imperial College, London, United Kingdom.
Brajesh K LalDepartment of Vascular Surgery, University of Maryland School of Medicine, Baltimore, MD; Department of Vascular Surgery, Baltimore VA Medical Center, Baltimore, MD; Department of Neurology, Mayo Clinic, Rochester, MN.
Armando MansilhaFaculty of Medicine of the University of Porto, Porto, Portugal; Department of Angiology and Vascular Surgery, Hospital de S. Joao, Porto, Portugal.
Pier Luigi AntignaniVascular Centre, Nuova Villa Claudia, Rome, Italy.
Gert J de BorstDepartment of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Richard P CambriaDivision of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Boston, MA.
Ian M LoftusSt George's Vascular Institute, St George's University London, London, United Kingdom.
Carl J LavieJohn Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA.
Ales BlincDivision of Internal Medicine, Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Sean P LydenDepartment of Vascular Surgery, The Cleveland Clinic, Cleveland, OH.
Jon S MatsumuraDepartment of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI.
Mateja K JezovnikDepartment of Advanced Cardiopulmonary Therapies and Transplantation, The University of Texas Health Science Centre at Houston, Houston, TX.
J Michael BacharachDepartment of Vascular Medicine and Endovascular Intervention, North Central Heart Institute and the Avera Heart Hospital, Sioux Falls, SD.
James F MeschiaDepartment of Neurology, Mayo Clinic, Jacksonville, FL.
Daniel G ClairDepartment of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN.
Clark J ZeebregtsDepartment of Surgery (Division of Vascular Surgery), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Gaetano LanzaVascular Surgery Department, IRCSS Multimedica Hospital, Castellanza, Italy.
Laura CapocciaVascular Surgery Division, Department of Surgery, SS. Filippo e Nicola Hospital, Avezzano, Italy.
Francesco SpinelliVascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Christos D LiapisAthens Vascular Research Center, Athens, Greece.
Arkadiusz JawienDepartment of Vascular Surgery and Angiology, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
Sahil A ParikhDivision of Cardiology, Department of Medicine, New York-Presbyterian Hospital/ Columbia University Irving Medical Center, New York, NY; Center for Interventional Cardiovascular Care and Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY.
Alexei SvetlikovDivision of Vascular and Endovascular Surgery, North-Western Scientific Clinical Center of Federal Medical Biological Agency of Russia, St Petersburg, Russia.
Gabor MenyheiDepartment of Vascular Surgery, University of Pecs, Pecs, Hungary.
Alun H DaviesDepartment of Surgery and Cancer, Section of Vascular Surgery, Imperial College London, Charing Cross Hospital, London, United Kingdom.
Piotr MusialekJagiellonian University Department of Cardiac and Vascular Diseases, John Paul II Hospital, Krakow, Poland.
Gary RoubinDepartment of Cardiology, Cardiovascular Associates of the Southeast/ Brookwood, Baptist Medical Center, Birmingham, AL.
Francesco StiloVascular Surgery Division, Department of Medicine and Surgery, Campus Bio-Medico University of Rome, Rome, Italy.
Sherif SultanDepartment of Vascular and Endovascular Surgery, Western Vascular Institute, University Hospital Galway, University of Galway, Galway, Ireland.
Robert M ProczkaFirst Department of Vascular Surgery, Medicover Hospital, Warsaw, Poland, Lazarski University Faculty of Medicine, Warsaw, Poland.
Gianluca FaggioliVascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
George GeroulakosDepartment of Vascular Surgery, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Jose Fernandes E FernandesFaculty of Medicine, Lisbon Academic Medical Center, University of Lisbon, Portugal, Hospital da Luz Torres de Lisboa, Lisbon, Portugal.
Jean-Baptiste RiccoDepartment of Vascular Surgery, University Hospital of Toulouse, Toulouse, France.
Luca SabaDepartment of Radiology, Azienda Ospedaliera Universitaria Di Cagliari, Cagliari, Italy.
Eric A SecemskyDivision of Cardiology, Department of Medicine, Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
Rodolfo PiniVascular Surgery, University of Bologna "Alma Mater Studiorum", Policlinico S. Orsola Malpighi, Bologna, Italy.
Piotr MyrchaDepartment of General and Vascular Surgery, Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland.
Tatjana RundekDepartment of Neurology, Miller School of Medicine, University of Miami, Miami, FL.
Ombretta MartinelliFaculty of Medicine, Sapienza University of Rome, Rome, Italy; Vascular Surgery Unit, "Umberto I." Hospital, Rome, Italy.
Stavros K KakkosDepartment of Vascular Surgery, University of Patras Medical School, Patras, Greece.
Ravish SacharNorth Carolina Heart and Vascular Hospital, UNC-REX Healthcare, University of North Carolina, Raleigh, NC.
Guillaume GoudotVascular Medicine Department, Georges Pompidou European Hospital, APHP, Université Paris Cité, Paris, France.
Felix SchlachetzkiDepartment of Neurology, University Hospital of Regensburg, Regensburg, Germany.
George S LavensonDepartment of Surgery, Uniformed Services University, Bethesda, MD.
Stefano RicciNeurology Department-Stroke Unit, Gubbio-Gualdo Tadino and Citta di Castello Hospitals, USL Umbria 1, Perugia, Italy.
Raffi TopakianDepartment of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria.
Antoine MillonDepartment of Vascular and Endovascular Surgery, Louis Pradel Hospital, Hospices Civil de Lyon, Bron, France.
Vincenzo Di LazzaroDepartment of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology and Psychiatry, Universita Campus Bio-Medico di Roma, Roma, Italy; Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy.
Mauro SilvestriniDepartment of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Ancona, Italy.
Seemant ChaturvediDepartment of Neurology, University of Maryland School of Medicine, Baltimore, MD.
Hans-Henning EcksteinDepartment for Vascular and Endovascular Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Peter GloviczkiDivision of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN.
Christopher J WhiteDepartment of Medicine and Cardiology, Ochsner Clinical School, University of Queensland, Brisbane, Australia; Department of Cardiology, The John Ochsner Heart and Vascular Institute, New Orleans, LA.

Funding

CREST-2 Clinical Coordinating CenterU01NS080168 · NINDS · MAYO CLINIC JACKSONVILLE · PI Thomas G Brott, JAMES F MESCHIA · 2014 to 2026
$56.3M
Miami Clinical and Translational Science InstituteUL1TR002736 · NCATS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI CARRASQUILLO, OLVEEN, KOBETZ, ERIN N · 2018 to 2022
$23.2M
STROKE INCIDENCE AND RISK FACTORS IN A TRI-ETHNIC REGIONR01NS029993 · NINDS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI ELKIND, MITCHELL S, SACCO, RALPH L. · 1993 to 2019
$19.2M
FAMILY STUDY OF STROKE RISK AND CAROTID ATHEROSCLEROSISR01NS040807 · NINDS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI BLANTON, SUSAN HALLORAN, RUNDEK, TATJANA · 2002 to 2022
$12.2M
Long-Term Observational Extension of Participants in the CREST-2 Randomized Clinical TrialU01NS119169 · NINDS · MAYO CLINIC JACKSONVILLE · PI HOWARD, GEORGE, LAL, BRAJESH K · 2021 to 2025
$3.8M
Institutional Career Development CoreKL2TR002737 · NCATS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI RUNDEK, TATJANA, SCOTT, GWENDOLYN BARBARA · 2018 to 2022
$3.6M
Disparities in Transition of Care after Acute Stroke Hospitalization: The Transition of Care Stroke Disparity Study (TCSD-S)R01MD012467 · NIMHD · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI ROMANO, JOSE G, RUNDEK, TATJANA · 2017 to 2021
$3.6M
Florida Regional Coordinating Center for the NINDS Stroke Trials NetworkU24NS107267 · NINDS · UNIVERSITY OF MIAMI SCHOOL OF MEDICINE · PI JOSE G ROMANO · 2018 to 2026
$3.0M
Shared Decision-Making to Improve the Health Status of Patients with Claudication: Developing and Implementing Strategies to Individualize Treatment DecisionsK23HL150290 · NHLBI · BETH ISRAEL DEACONESS MEDICAL CENTER · PI SECEMSKY, ERIC ALEXANDER · 2020 to 2024
$851k
NCATS NIH HHS KL2 TR002737NCATS NIH HHS UL1 TR002736NHLBI NIH HHS K23 HL150290NIMHD NIH HHS R01 MD012467NINDS NIH HHS R01 NS029993NINDS NIH HHS R01 NS040807NINDS NIH HHS U01 NS080168NINDS NIH HHS U01 NS119169NINDS NIH HHS U24 NS107267
6 · The paper itself

Abstract

objectiveDespite the publication of various national/international guidelines, several questions concerning the management of patients with asymptomatic (AsxCS) and symptomatic (SxCS) carotid stenosis remain unanswered. The aim of this international, multi-specialty, expert-based Delphi Consensus document was to address these issues to help clinicians make decisions when guidelines are unclear.

methodsFourteen controversial topics were identified. A three-round Delphi Consensus process was performed including 61 experts. The aim of Round 1 was to investigate the differing views and opinions regarding these unresolved topics. In Round 2, clarifications were asked from each participant. In Round 3, the questionnaire was resent to all participants for their final vote. Consensus was reached when ≥75% of experts agreed on a specific response.

resultsMost experts agreed that: (1) the current periprocedural/in-hospital stroke/death thresholds for performing a carotid intervention should be lowered from 6% to 4% in patients with SxCS and from 3% to 2% in patients with AsxCS; (2) the time threshold for a patient being considered "recently symptomatic" should be reduced from the current definition of "6 months" to 3 months or less; (3) 80% to 99% AsxCS carries a higher risk of stroke compared with 60% to 79% AsxCS; (4) factors beyond the grade of stenosis and symptoms should be added to the indications for revascularization in AsxCS patients (eg, plaque features of vulnerability and silent infarctions on brain computed tomography scans); and (5) shunting should be used selectively, rather than always or never. Consensus could not be reached on the remaining topics due to conflicting, inadequate, or controversial evidence.

conclusionsThe present international, multi-specialty expert-based Delphi Consensus document attempted to provide responses to several unanswered/unresolved issues. However, consensus could not be achieved on some topics, highlighting areas requiring future research.

Indexed as

Carotid StenosisStrokeConstriction, PathologicDelphi TechniqueHumansAsymptomatic carotid stenosisDelphi ConsensusStrokeSymptomatic carotid stenosisTransient ischemic attack

Identifiers

PMID37944771
PMCPMC12728508

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.