Grade of Stenosis Was Not Explained
The authors from the guideline group excellently summarized the diagnostic evaluation, treatment, and follow-up in extracranial carotid stenosis as per the recently published clinical practice (S3) guideline (3) for the Deutsches Ärzteblatt (2).
For the criteria in favor of revascularization in asymptomatic carotid stenosis, the flowing text mentions findings that are associated with a higher carotid-related stroke risk and therefore support an indication for intervention or surgery. These are listed in Table 3. But Table 3 additionally list a further factor (50–69% asymptomatic carotid stenosis: stroke risk 1.6%/year; 70–99% asymptomatic carotid stenosis: stroke risk 2.4%/year), which is not mentioned in the text but may be of great importance for routine clinical practice. Can the NASCET criterion ≥70% stenosis (flow velocity >300 cm) be considered an equally valid morphological criterion for the indication for revascularization? In our triple-certified vascular center we introduced this parameter as an indication criterion years ago and do not treat asymptomatic stenoses <70% NASCET.
Prof. Dr. med. Johannes N. Hoffmann
Klinik für Gefäßchirurgie und Phlebologie, Essen
|1.||Eckstein HH, et al.: S3 Leitlinie zur Diagnostik, Therapie und Nachsorge der extracraniellen Carotisstenose. www.awmf.org/uploads/tx_szleitlinien/004-028l_extracranielle-Carotisstenose-Diagnostik-Therapie-Nachsorge_2020-02_03.pdf (last accessed on 18 February 2021).|
|2.||Eckstein HH, Kühnl A, Berkefeld J, Lawall H, Storck M, Sander D: Clinical practice guideline: Diagnosis, treatment and follow-up in extracranial carotid stenosis. Dtsch Arztebl Int 2020; 117: 801–7 VOLLTEXT|