Transfemoral carotid artery stent placement for asymptomatic extracranial carotid stenosis
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1 Draft recommendations
1.1 Transfemoral carotid artery stent placement for asymptomatic extracranial carotid stenosis should only be used with special arrangements for clinical governance, consent, and audit or research. Find out what special arrangements mean on the NICE interventional procedures guidance page.
1.2 Clinicians wanting to do transfemoral carotid artery stent placement for asymptomatic extracranial carotid stenosis should:
Tell the clinical governance leads in their healthcare organisation.
Make sure that people (and their families and carers as appropriate) understand the procedure's safety and efficacy, and any uncertainties about these.
Consider NICE's advice on shared decision making, including NICE's information for the public.
Audit and review clinical outcomes of everyone having the procedure. The main efficacy and safety outcomes identified in this guidance can be entered into NICE's interventional procedure outcomes audit tool (for use at local discretion).
Discuss the outcomes of the procedure during their annual appraisal to reflect, learn and improve.
1.3 Healthcare organisations should:
Make sure systems are in place that support clinicians to collect and report data on outcomes and safety for everyone having this procedure.
Regularly review data on outcomes and safety for this procedure.
1.4 Patient selection should be done by a multidisciplinary team that should include an interventional radiologist or a neuroradiologist, a vascular surgeon, and a stroke physician or neurologist.
1.5 The procedure should only be done by clinicians with specific training and expertise in this technique.
1.6 NICE encourages clinicians to submit data to the National Vascular Registry.
1.7 Further research should include details of patient selection and report longer-term outcomes.
Why the committee made these recommendations
This guidance considers additional evidence that has been collected since the original NICE interventional procedures guidance on carotid artery stent placement for asymptomatic extracranial carotid stenosis.
There is still uncertainty about this procedure's use in asymptomatic extracranial carotid stenosis. Short-term evidence suggests that the risk of disabling stroke is similar in people who have this procedure compared with people who have conventional surgery. But, more long-term evidence beyond 10 years is needed. It is also uncertain how well the procedure works compared with current standard medical therapy. More research is also needed to identify which people might benefit most from this procedure. So, it is recommended only with special arrangements.
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