SVS Guidelines for management of extracranial cerebrovascular disease скачать в хорошем качестве

SVS Guidelines for management of extracranial cerebrovascular disease

#CarotidStenosis #StrokePrevention #SVSGuidelines #CEA #CAS #TCR #MedicalManagement #Screening #CombinedDisease #VascularSurgery The updated Society for Vascular Surgery (SVS) guidelines for extracranial cerebrovascular disease critically reevaluate stroke prevention and treatment, using a rigorous GRADE methodology. Key recommendations include: *Asymptomatic Stenosis (more than 70%, low risk):* Carotid Endarterectomy (CEA) plus best medical therapy (BMT) is strongly recommended over BMT alone (Grade 1B) for long-term stroke prevention. *Symptomatic Stenosis (more than 50%, low risk):* CEA is strongly recommended over transfemoral carotid artery stenting (TFCAS) (Grade 1A) due to lower peri-procedural stroke/death rates. Transcarotid Artery Revascularization (TCR) shows promise, potentially preferred for high-risk patients, but needs more data for first-line use in low-risk individuals. *Timing After Acute Stroke:* For stable strokes (Rankin 0-2), revascularisation (preferably CEA) is recommended between 48 hours and 14 days post-symptom onset (Grade 1B). Early revascularisation is strongly contraindicated for disabling strokes or large infarcts (Grade 1C) due to haemorrhage risk. *Screening Asymptomatic Patients:* Routine general population screening is not recommended (Grade 1B). Screening is suggested (Grade 2B) for high-risk groups (e.g., PAD, pre-CABG, older with multiple risk factors). Duplex ultrasound in an accredited lab is the recommended screening tool (Grade 1B). *Combined Carotid/Coronary Disease:* Recommendations are weak (Grade 2C) due to low evidence. For symptomatic carotid stenosis needing CABG, CEA before or concomitant is suggested, with sequencing dependent on clinical presentation and institutional experience. Shared decision-making is crucial.