Patient-specific treatment allocation for carotid artery disease

Different approaches can be followed to allocate patients eligible for carotid revascularization to either stenting or endarterectomy. Recently, the Society for Vascular Surgery published in their clinical practice guidelines for carotid revascularization an allocation algorithm based on the patients’ surgical risk. Although the algorithm is firmly based on the available evidence from different randomized controlled trials, taking into account more recently published data on the same trials and the constant evolution in interventional techniques, it is questionable whether this conventional algorithm will resist time. An alternative algorithm allocating patients to either carotid endarterectomy or stenting is based on published high-patient and lesion profiles for suboptimal carotid artery stenting outcome. It was successfully introduced in two high-volume centers and might help in lowering the 30-day complication rates for both carotid revascularization strategies.