Department of Vascular Surgery, IRCCS MultiMedica, Castellanza Hospital, Castellanza, Varese, Italy.
Experimental Zooprophylactic Institute of Umbria and Marche, Perugia, Italy.
J Cardiovasc Surg (Torino). 2022 Aug;63(4):471-491. doi: 10.23736/S0021-9509.22.12368-2.
This guideline (GL) on carotid surgery as updating of "Stroke: Italian guidelines for Prevention and Treatment" of the ISO-SPREAD Italian Stroke Organization-Group, has recently been published in the National Guideline System and shared with the Italian Society of Vascular and Endovascular Surgery (SICVE) and other Scientific Societies and Patient's Association.
GRADE-SIGN version, AGREE quality of reporting checklist. Clinical questions formulated according to the PICO model. Recommendations developed based on clinical questions by a multidisciplinary experts' panel and patients' representatives. Systematic reviews performed for each PICO question. Considered judgements filled by assessing the evidence level, direction, and strength of the recommendations.
The panel provided indications and recommendations for appropriate, comprehensive, and individualized management of patients with carotid stenosis. Diagnostic and therapeutic processes of the best medical therapy, carotid endarterectomy (CEA), carotid stenting (CAS) according to the evidences and the judged opinions were included. Symptomatic carotid stenosis in elective and emergency, asymptomatic carotid stenosis, association with ischemic heart disease, preoperative diagnostics, types of anesthesia, monitoring in case of CEA, CEA techniques, comparison between CEA and CAS, post-surgical carotid restenosis, and medical therapy are the main topics, even with analysis of uncertainty areas for risk-benefit assessments in the individual patient (personalized medicine [PM]).
This GL updates on the main recommendations for the most appropriate diagnostic and medical-surgical management of patients with atherosclerotic carotid artery stenosis to prevent ischemic stroke. This GL also provides useful elements for the application of PM in good clinical practice.
本指南（GL）是对意大利 ISO-SPREAD 卒中组织-集团《卒中：意大利预防和治疗指南》的更新，最近已在国家指南系统中发布，并与意大利血管和血管外科学会（SICVE）以及其他科学学会和患者协会共享。
采用 GRADE-SIGN 版本、AGREE 报告质量清单。根据 PICO 模型制定临床问题。推荐意见由多学科专家小组和患者代表根据临床问题制定。针对每个 PICO 问题进行系统评价。通过评估证据水平、推荐意见的方向和强度，对考虑的判断进行了补充。
专家组为颈动脉狭窄患者的适当、全面和个体化管理提供了指示和建议。纳入了最佳药物治疗、颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）的诊断和治疗流程，依据的是证据和判断意见。包括择期和紧急情况下的症状性颈动脉狭窄、无症状性颈动脉狭窄、与缺血性心脏病的关联、术前诊断、麻醉类型、CEA 时的监测、CEA 技术、CEA 与 CAS 比较、术后颈动脉再狭窄以及药物治疗等主要议题，甚至对个体患者风险-效益评估的不确定性领域（个体化医学[PM]）进行了分析。
本 GL 更新了动脉粥样硬化性颈动脉狭窄患者最适当的诊断和药物-手术管理的主要建议，以预防缺血性卒中。本 GL 还为良好临床实践中 PM 的应用提供了有用的要素。
