04 Feb 21. Featured Paper

Multi-national survey of current practice from imaging to treatment of atherosclerotic carotid stenosis.

Link to paper on Cerebrovascular Diseases

Authors

Saba L., Mossa-Basha M., Abbott A., Lanzino G., Wardlaw J.M, Hatsukami T.S., Micheletti G, Balestrieri A., Hedin U., Moody A.R., Wintermark M., DeMarco J.K.

Abstract

Background: In the last 20–30 years, there have been many advances in imaging & therapeutic strategies for symptomatic & asymptomatic individuals with carotid artery stenosis.

Our aim was to examine contemporary multinational practice standards. 

Methods: Departmental Review Board approval for this study was obtained, & 3 authors prepared the 44 multiple choice survey questions.

Endorsement was obtained by the European Society of Neuroradiology, American Society of Functional Neuroradiology, & African Academy of Neurology.

A link to the online questionnaire was sent to their respective members & members of the Faculty Advocating Collaborative & Thoughtful Carotid Artery Treatments (FACTCATS).

The questionnaire was open from May 16 to July 16, 2019. 

Results: The responses from 223 respondents from 46 countries were included in the analyses including 65.9% from academic university hospitals.

Neuroradiologists/radiologists comprised 68.2% of respondents, followed by neurologists (15%) & vascular surgeons (12.9%).

In symptomatic patients, half (50.4%) the respondents answered that the first exam they used to evaluate carotid bifurcation was ultrasound, followed by computed tomography angiography (CTA, 41.6%) & then magnetic resonance imaging (MRI 8%).

In asymptomatic patients, the first exam used to evaluate carotid bifurcation was ultrasound in 88.8% of respondents, CTA in 7%, & MRA in 4.2%.

The percent stenosis upon which carotid endarterectomy or stenting was recommended was reduced in the presence of imaging evidence of “vulnerable plaque features” by 66.7% respondents for symptomatic patients & 34.2% for asymptomatic patients with a smaller subset of respondents even offering procedural intervention to patients with <50% symptomatic or asymptomatic stenosis.

Conclusions: We found heterogeneity in current practices of carotid stenosis imaging & management in this worldwide survey with many respondents including vulnerable plaque imaging into their decision analysis despite the lack of proven benefit from clinical trials.

This study highlights the need for new clinical trials using vulnerable plaque imaging to select high-risk patients despite maximal medical therapy who may benefit from procedural intervention.

Keywords

• Carotid arteries

• Computed tomography

• Imaging

• Magnetic resonance

• Questionnaire