Periprocedural Management of Patients Undergoing Carotid Endarterectomy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Periprocedural Management of Patients Undergoing Carotid Endarterectomy

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 (DO NOT EDIT)

Recommendations for Periprocedural Management of Patients Undergoing Carotid Endarterectomy

Class I

"1. Aspirin (81 to 325 mg daily) is recommended before CEA and may be continued indefinitely postoperatively (Level of Evidence: A)"

"2. Beyond the first month after CEA, aspirin (75 to 325 mg daily), clopidogrel (75 mg daily), or the combination of low-dose aspirin plus extended-release dipyridamole (25 and 200 mg twice daily, respectively) should be administered for long-term prophylaxis against ischemic cardiovascular events (Level of Evidence: B)"

"3. Administration of antihypertensive medication is recommended as needed to control blood pressure before and after CEA. (Level of Evidence: C)"

"4. The findings on clinical neurological examination should be documented within 24 hours before and after CEA. (Level of Evidence: C)"

Class IIa

"1. Patch angioplasty can be beneficial for closure of the arteriotomy after CEA (Level of Evidence: B) "

"2. Administration of statin lipid-lowering medication for prevention of ischemic events is reasonable for patients who have undergone CEA irrespective of serum lipid levels, although the optimum agent and dose and the efficacy for prevention of restenosis have not been established (Level of Evidence: B) "

"3. Noninvasive imaging of the extracranial carotid arteries is reasonable 1 month, 6 months, and annually after CEA to assess patency and exclude the development of new or contralateral lesions. Once stability has been established over an extended period, surveillance at longer intervals may be appropriate. Termination of surveillance is reasonable when the patient is no longer a candidate for intervention (Level of Evidence: C) "