The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Carotid artery stent placement for symptomatic extracranial carotid stenosis.
It replaces the previous guidance on carotid artery stent placement for carotid stenosis (NICE interventional procedures guidance 191, September 2006).
NICE has also published guidance on carotid artery stent placement for asymptomatic extracranial carotid stenosis (NICE interventional procedures guidance 388, April 2011).
The main arteries in the neck (the carotid arteries) can become narrowed by fatty deposits. Blood clots can form on these fatty deposits and fragments can detach and lodge in thinner arteries that supply blood to parts of the brain, causing a transient ischaemic attack (TIA, sometimes called a ‘mini stroke’) or a stroke.
In this procedure a metal mesh called a stent is used to widen the narrowed carotid artery. This procedure does not involve making a cut in the neck. Instead a fine wire is inserted into an artery in the leg and passed up into the carotid artery, and the stent is then moved into place along the wire. Some stenting also includes protective devices, to help to prevent any fragments loosened by the stent insertion from reaching smaller arteries and causing a stroke.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.