Percutaneous transarterial carotid artery stent placement for asymptomatic extracranial carotid stenosis

NICE did a rapid review of the published literature on the efficacy and safety of this procedure. This comprised a comprehensive literature search and detailed review of the evidence from 9 sources, which was discussed by the committee. The evidence included 3 systematic reviews, 2 randomised controlled trials, 1 prospective cohort study, 2 retrospective cohort studies and 1 retrospective international administrative dataset. It is presented in the summary of key evidence section in the interventional procedures overview. Other relevant literature is in table 5 of the overview.

The professional experts and the committee considered the key efficacy outcome to be: stroke prevention.

The professional experts and the committee considered the key safety outcomes to be: stroke, infection, haemorrhage, restenosis.

One commentary from a person who had this procedure was discussed by the committee.

The committee was informed that simulation training for the procedure is available.

The committee noted that there are several ongoing clinical trials.

The committee noted that technical aspects of the procedure, such as stent design and cerebral protection devices, have changed over time.

The committee were informed that the use of a transradial approach is increasing, but noted that most of the published evidence that was considered used a transfemoral approach.

The committee noted that although there is new information, there is still uncertainty about the role of this intervention in people with asymptomatic carotid stenosis.