This document replaces previous guidance on carotid artery stent placement for carotid stenosis (interventional procedure guidance 191).
1.1 Current evidence on the safety of carotid artery stent placement for asymptomatic extracranial carotid stenosis shows well-documented risks, in particular the risk of stroke. The evidence on efficacy is inadequate in quantity. Therefore this procedure should only be used with special arrangements for clinical governance, consent and audit or research.
1.2 Clinicians wishing to undertake carotid artery stent placement for asymptomatic extracranial carotid stenosis should take the following actions.
Ensure that patients and their carers understand the uncertainty about the procedure's efficacy, the risk of stroke and other complications, and the reasons for advising stenting rather than endarterectomy or best medical treatment alone in their particular case. Patients should be provided with clear written information. In addition, the use of NICE's information for patients ('Understanding NICE guidance') is recommended.
1.3 Patient selection should be carried out by a multidisciplinary team, which should include an interventional radiologist or a neuroradiologist, a vascular surgeon and a physician with specialist interest in stroke. Cardiac surgeons and cardiologists should liaise with the multidisciplinary team in relation to patients being considered for this procedure as a prelude to cardiac surgery.
1.4 This procedure should only be carried out by clinicians with specific training and expertise in the technique who regularly perform complex endovascular interventions. The Royal College of Radiologists has produced training standards.
1.5 NICE encourages clinicians either to enter patients into the ACST-2 trial (Asymptomatic Carotid Artery Surgery Trial 2) or to submit data to the Endovascular Carotid Register, run by the British Society of Interventional Radiology and the Vascular Society of Great Britain and Ireland. NICE may review this procedure on publication of further evidence.