Management of Patients with Asymptomatic and Symptomatic Carotid Artery Disease: Update on Anti-Thrombotic Therapy

Daniele Pastori; John W. Eikelboom; Sonia S. Anand; Manesh Raman Patel; Jean-Francois Tanguay; Jean-Baptiste Ricco; Eike Sebastian Debus; Lucia Mazzolai; Rupert Bauersachs; Peter Verhamme; Jackie Bosch; Sigrid Nikol; Mark Nehler; Victor Aboyans; Francesco Violi

doi:10.1055/s-0039-1678527

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2019; 119(04): 576-585
DOI: 10.1055/s-0039-1678527

Review Article

Georg Thieme Verlag KG Stuttgart · New York

Management of Patients with Asymptomatic and Symptomatic Carotid Artery Disease: Update on Anti-Thrombotic Therapy

Daniele Pastori

¹I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

,

John W. Eikelboom

²Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Sonia S. Anand

³Department of Medicine, Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

,

Manesh Raman Patel

⁴Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, United States

,

Jean-Francois Tanguay

⁵Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Québec, Canada

,

Jean-Baptiste Ricco

⁶Department of Clinical Research and Innovation (DRCI), University Hospital of Poitiers, Poitiers, France

,

Eike Sebastian Debus

⁷Department of Vascular Medicine, University Heart Center Hamburg, Hamburg, Germany

,

Lucia Mazzolai

⁸Division of Angiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland

,

Rupert Bauersachs

⁹Department of Vascular Medicine, Klinikum Darmstadt GmbH, Darmstadt, Germany

¹⁰Center of Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany

,

Peter Verhamme

¹¹Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, University of Leuven, Leuven, Belgium

,

Jackie Bosch

¹²Population Health Research Institute, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada

¹³School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada

,

Sigrid Nikol

¹⁴Department of Clinical and Interventional Angiology, Asklepios Klinik St. Georg, Hamburg, Germany

,

Mark Nehler

¹⁵CPC Research, Aurora, Colorado, United States

,

Victor Aboyans

¹⁶Department of Cardiology, Dupuytren University Hospital, 2, Martin Luther King Ave, Limoges, France

¹⁷Research Unit INSERM 1094, Faculté de médecine de Limoges, Limoges, France

,

Francesco Violi

¹I Clinica Medica, Atherothrombosis Centre, Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy

› Institutsangaben

Abstract

The most common causes of ischaemic stroke are represented by carotid artery atherosclerotic disease (CAAD) and atrial fibrillation. While oral anticoagulants substantially reduce the incidence of thromboembolic stroke (< 1%/year), the rate of ischaemic stroke and other cardiovascular disease events in patients with CAAD remains high, ranging from 8.4 to 18.1 events per 100 patient-years. Similar to any other atherosclerotic disease, anti-thrombotic therapies are proposed for CAAD to reduce stroke and other cardiovascular events. The 2017 European Society of Cardiology (ESC)/European Society for Vascular Surgery (ESVS) guidelines recommend for patients with asymptomatic CAAD ≥60% the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily at the exception of patient at very high bleeding risk. For patients with symptomatic CAAD ≥50%, the use of aspirin 75 to 100 mg once daily or clopidogrel 75 mg once daily is recommended. New perspectives for anti-thrombotic therapy for the treatment of patients with CAAD come from the novel dual pathway strategy combining a low-dose anticoagulant (i.e. rivaroxaban) and aspirin that may help reduce long-term ischaemic complications in patients with CAAD. This review summarizes current evidence and recommendations for the anti-thrombotic management of patients with symptomatic or asymptomatic CAAD or those undergoing carotid revascularization.

Keywords

carotid artery disease - anti-thrombotic therapy - anti-platelet - anticoagulant - rivaroxaban - aspirin

Volltext

Referenzen

References
1 Bansilal S, Castellano JM, Fuster V. Global burden of CVD: focus on secondary prevention of cardiovascular disease. Int J Cardiol 2015; 201 (Suppl. 01) S1-S7
2 Camm AJ, Lip GY, De Caterina R. , et al; ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J 2012; 33 (21) 2719-2747
3 Adams Jr HP, Bendixen BH, Kappelle LJ. , et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993; 24 (01) 35-41
4 Investigators SPiAF. Stroke prevention in atrial fibrillation study. Final results. Circulation 1991; 84 (02) 527-539
5 Ruff CT, Giugliano RP, Braunwald E. , et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014; 383 (9921): 955-962
6 Amarenco P, Bogousslavsky J, Caplan LR, Donnan GA, Hennerici MG. Classification of stroke subtypes. Cerebrovasc Dis 2009; 27 (05) 493-501
7 Niu PP, Guo ZN, Jin H, Xing YQ, Yang Y. Antiplatelet regimens in the long-term secondary prevention of transient ischaemic attack and ischaemic stroke: an updated network meta-analysis. BMJ Open 2016; 6 (03) e009013
8 Anand SS, Bosch J, Eikelboom JW. , et al; COMPASS Investigators. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391 (10117): 219-229
9 Langhoff R. Carotid stenosis - basing treatment on individual patients' needs. Optimal medical therapy alone or accompanied by stenting or endarterectomy. Vasa 2018; 47 (01) 7-16
10 Herder M, Johnsen SH, Arntzen KA, Mathiesen EB. Risk factors for progression of carotid intima-media thickness and total plaque area: a 13-year follow-up study: the Tromsø Study. Stroke 2012; 43 (07) 1818-1823
11 Violi F, Loffredo L, Carnevale R, Pignatelli P, Pastori D. Atherothrombosis and oxidative stress: mechanisms and management in elderly. Antioxid Redox Signal 2017; 27 (14) 1083-1124
12 Mathiesen EB, Joakimsen O, Bønaa KH. Prevalence of and risk factors associated with carotid artery stenosis: the Tromsø Study. Cerebrovasc Dis 2001; 12 (01) 44-51
13 Wang TJ, Nam BH, Wilson PW. , et al. Association of C-reactive protein with carotid atherosclerosis in men and women: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2002; 22 (10) 1662-1667
14 O'Leary DH, Polak JF, Kronmal RA. , et al; The CHS Collaborative Research Group. Distribution and correlates of sonographically detected carotid artery disease in the Cardiovascular Health Study. Stroke 1992; 23 (12) 1752-1760
15 LeFevre M. ; U.S. Preventive Services Task Force. Screening for asymptomatic carotid artery stenosis: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2014; 161 (05) 356-362
16 Brott TG, Halperin JL, Abbara S. , et al; American College of Cardiology; American Stroke Association; American Association of Neurological Surgeons; American College of Radiology; American College of Radiology; Society of NeuroInterventional Surgery; Society for Vascular Medicine; Society for Vascular Surgery. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Circulation 2011; 124 (04) e54-e130
17 Meschia JF, Bushnell C, Boden-Albala B. , et al; American Heart Association Stroke Council; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45 (12) 3754-3832
18 de Weerd M, Greving JP, de Jong AW, Buskens E, Bots ML. Prevalence of asymptomatic carotid artery stenosis according to age and sex: systematic review and metaregression analysis. Stroke 2009; 40 (04) 1105-1113
19 de Weerd M, Greving JP, Hedblad B. , et al. Prediction of asymptomatic carotid artery stenosis in the general population: identification of high-risk groups. Stroke 2014; 45 (08) 2366-2371
20 Piepoli MF, Hoes AW, Agewall S. , et al; ESC Scientific Document Group. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37 (29) 2315-2381
21 Paciaroni M, Bogousslavsky J. Antithrombotic therapy in carotid artery stenosis: an update. Eur Neurol 2015; 73 (1-2): 51-56
22 Kwon H, Kim HK, Kwon SU. , et al. Risk of major adverse cardiovascular events in subjects with asymptomatic mild carotid artery stenosis. Sci Rep 2018; 8 (01) 4700
23 Chimowitz MI, Kokkinos J, Strong J. , et al. The warfarin-aspirin symptomatic intracranial disease study. Neurology 1995; 45 (08) 1488-1493
24 García-Pastor A, Gil-Núñez A, Ramírez-Moreno JM. , et al; Stroke Project of the Spanish Cerebrovascular Diseases Study Group. Early risk of recurrent stroke in patients with symptomatic carotid near-occlusion: results from CAOS, a multicenter registry study. Int J Stroke 2017; 12 (07) 713-719
25 Johansson E, Cuadrado-Godia E, Hayden D. , et al. Recurrent stroke in symptomatic carotid stenosis awaiting revascularization: a pooled analysis. Neurology 2016; 86 (06) 498-504
26 Aboyans V, Ricco JB, Bartelink MEL. , et al. ESC Guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries. Endorsed by: the European Stroke Organization (ESO), The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39 (09) 763-781
27 Pastori D, Pignatelli P, Sciacqua A, Perticone M, Violi F, Lip GYH. Relationship of peripheral and coronary artery disease to cardiovascular events in patients with atrial fibrillation. Int J Cardiol 2018; 255: 69-73
28 Brott TG, Hobson II RW, Howard G. , et al; CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med 2010; 363 (01) 11-23
29 Meschia JF, Klaas JP, Brown Jr RD, Brott TG. Evaluation and management of atherosclerotic carotid stenosis. Mayo Clin Proc 2017; 92 (07) 1144-1157
30 De Rango P, Parlani G, Verzini F. , et al. Long-term prevention of stroke: a modern comparison of current carotid stenting and carotid endarterectomy. J Am Coll Cardiol 2011; 57 (06) 664-671
31 Timaran CH, Mantese VA, Malas M. , et al; CREST Investigators. Differential outcomes of carotid stenting and endarterectomy performed exclusively by vascular surgeons in the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST). J Vasc Surg 2013; 57 (02) 303-308
32 Safian RD. Asymptomatic carotid artery stenosis: revascularization. Prog Cardiovasc Dis 2017; 59 (06) 591-600
33 Abbott AL, Paraskevas KI, Kakkos SK. , et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 2015; 46 (11) 3288-3301
34 Moresoli P, Habib B, Reynier P, Secrest MH, Eisenberg MJ, Filion KB. Carotid stenting versus endarterectomy for asymptomatic carotid artery stenosis: a systematic review and meta-analysis. Stroke 2017; 48 (08) 2150-2157
35 Orrapin S, Rerkasem K. Carotid endarterectomy for symptomatic carotid stenosis. Cochrane Database Syst Rev 2017; 6: CD001081
36 Eckel RH, Jakicic JM, Ard JD. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129 (25) (Suppl. 02) S76-S99
37 Howard VJ, Meschia JF, Lal BK. , et al; CREST-2 study investigators. Carotid revascularization and medical management for asymptomatic carotid stenosis: protocol of the CREST-2 clinical trials. Int J Stroke 2017; 12 (07) 770-778
38 Freynhofer MK, Bruno V, Wojta J, Huber K. The role of platelets in athero-thrombotic events. Curr Pharm Des 2012; 18 (33) 5197-5214
39 Baigent C, Blackwell L, Collins R. , et al; Antithrombotic Trialists' (ATT) Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009; 373 (9678): 1849-1860
40 Côté R, Battista RN, Abrahamowicz M, Langlois Y, Bourque F, Mackey A. ; The Asymptomatic Cervical Bruit Study Group. Lack of effect of aspirin in asymptomatic patients with carotid bruits and substantial carotid narrowing. Ann Intern Med 1995; 123 (09) 649-655
41 Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet 2016; 388 (10042): 365-375
42 Markus HS, Droste DW, Kaps M. , et al. Dual antiplatelet therapy with clopidogrel and aspirin in symptomatic carotid stenosis evaluated using Doppler embolic signal detection: the Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis (CARESS) trial. Circulation 2005; 111 (17) 2233-2240
43 Wong KS, Chen C, Fu J. , et al; CLAIR study investigators. Clopidogrel plus aspirin versus aspirin alone for reducing embolisation in patients with acute symptomatic cerebral or carotid artery stenosis (CLAIR study): a randomised, open-label, blinded-endpoint trial. Lancet Neurol 2010; 9 (05) 489-497
44 Jones DW, Goodney PP, Conrad MF. , et al. Dual antiplatelet therapy reduces stroke but increases bleeding at the time of carotid endarterectomy. J Vasc Surg 2016; 63 (05) 1262-1270
45 Alcocer F, Novak Z, Combs BR. , et al. Dual antiplatelet therapy (clopidogrel and aspirin) is associated with increased all-cause mortality after carotid revascularization for asymptomatic carotid disease. J Vasc Surg 2014; 59 (04) 950-955
46 Huibers A, Halliday A, Bulbulia R, Coppi G, de Borst GJ. ; ACST-2 Collaborative Group. Antiplatelet Therapy in Carotid Artery Stenting and Carotid Endarterectomy in the Asymptomatic Carotid Surgery Trial-2. Eur J Vasc Endovasc Surg 2016; 51 (03) 336-342
47 Patti G, Tomai F, Melfi R. , et al. Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) study. J Am Coll Cardiol 2013; 61 (13) 1379-1387
48 Bauersachs R, Zannad F. Rivaroxaban: a new treatment paradigm in the setting of vascular protection?. Thromb Haemost 2018; 118 (Suppl. 01) S12-S22
49 Shahid F, Pastori D, Violi F. , et al. Prognostic and therapeutic implications of vascular disease in patients with atrial fibrillation. Pharmacol Res 2018; 132: 149-159
50 Eikelboom JW, Connolly SJ, Bosch J. , et al; COMPASS Investigators. Rivaroxaban with or without aspirin in stable cardiovascular disease. N Engl J Med 2017; 377 (14) 1319-1330
51 Connolly SJ, Eikelboom JW, Bosch J. , et al; COMPASS investigators. Rivaroxaban with or without aspirin in patients with stable coronary artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018; 391 (10117): 205-218
52 Bekwelem W, Jensen PN, Norby FL. , et al. Carotid atherosclerosis and stroke in atrial fibrillation: the atherosclerosis risk in communities study. Stroke 2016; 47 (06) 1643-1646
53 Basili S, Loffredo L, Pastori D. , et al; in collaboration with ARAPACIS Study Investigators. Carotid plaque detection improves the predictive value of CHA₂DS₂-VASc score in patients with non-valvular atrial fibrillation: the ARAPACIS Study. Int J Cardiol 2017; 231: 143-149
54 Kanter MC, Tegeler CH, Pearce LA. , et al. Carotid stenosis in patients with atrial fibrillation. Prevalence, risk factors, and relationship to stroke in the Stroke Prevention in Atrial Fibrillation Study. Arch Intern Med 1994; 154 (12) 1372-1377
55 Kochar A, Hellkamp AS, Lokhnygina Y. , et al. Efficacy and safety of rivaroxaban compared with warfarin in patients with carotid artery disease and nonvalvular atrial fibrillation: insights from the ROCKET AF trial. Clin Cardiol 2018; 41 (01) 39-45
56 Arya S, Khakharia A, Binney ZO. , et al. Association of statin dose with amputation and survival in patients with peripheral artery disease. Circulation 2018; 137 (14) 1435-1446
57 Investigators W. ; WAVE Investigators. The effects of oral anticoagulants in patients with peripheral arterial disease: rationale, design, and baseline characteristics of the Warfarin and Antiplatelet Vascular Evaluation (WAVE) trial, including a meta-analysis of trials. Am Heart J 2006; 151 (01) 1-9
58 Verheugt FW. Combined antiplatelet and novel oral anticoagulant therapy after acute coronary syndrome: is three a crowd?. Eur Heart J 2013; 34 (22) 1618-1620
59 Shen AY, Yao JF, Brar SS, Jorgensen MB, Chen W. Racial/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation. J Am Coll Cardiol 2007; 50 (04) 309-315
60 Lip GYH, Banerjee A, Boriani G. , et al. Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report. Chest 2018; 154 (05) 1121-1201
61 Al-Tamimi M, Grigoriadis G, Tran H. , et al. Coagulation-induced shedding of platelet glycoprotein VI mediated by factor Xa. Blood 2011; 117 (14) 3912-3920
62 Pignatelli P, Pastori D, Bartimoccia S. , et al. Anti Xa oral anticoagulants inhibit in vivo platelet activation by modulating glycoprotein VI shedding. Pharmacol Res 2016; 113 (Pt A): 484-489
63 Cammisotto V, Carnevale R, Nocella C. , et al. Rivaroxaban enhances the antiplatelet activity of aspirin via inhibition of Nox2-mediated thromboxane A2 and isoprostane biosynthesis. In: Vascular Discovery: From Genes to Medicine 2018 Scientific Sessions (Formerly ATVB|PVD Scientific Sessions). Dallas, TX: American Heart Association (AHA); 2018
64 Violi F, Carnevale R, Loffredo L, Pignatelli P, Gallin JI. NADPH oxidase-2 and atherothrombosis: insight from chronic granulomatous disease. Arterioscler Thromb Vasc Biol 2017; 37 (02) 218-225
65 Violi F, Carnevale R, Pastori D, Pignatelli P. Antioxidant and antiplatelet effects of atorvastatin by Nox2 inhibition. Trends Cardiovasc Med 2014; 24 (04) 142-148
66 Plichart M, Celermajer DS, Zureik M. , et al. Carotid intima-media thickness in plaque-free site, carotid plaques and coronary heart disease risk prediction in older adults. The Three-City Study. Atherosclerosis 2011; 219 (02) 917-924
67 Jeevarethinam A, Venuraju S, Dumo A. , et al. Usefulness of carotid plaques as predictors of obstructive coronary artery disease and cardiovascular events in asymptomatic individuals with diabetes mellitus. Am J Cardiol 2018; 121 (08) 910-916
68 Katakami N, Mita T, Gosho M. , et al. Clinical utility of carotid ultrasonography in the prediction of cardiovascular events in patients with diabetes: a combined analysis of data obtained in five longitudinal studies. J Atheroscler Thromb 2018; 25 (10) 1053-1066
69 Vigili de Kreutzenberg S, Fadini GP, Guzzinati S. , et al. Carotid plaque calcification predicts future cardiovascular events in type 2 diabetes. Diabetes Care 2015; 38 (10) 1937-1944
70 Kawai T, Ohishi M, Takeya Y. , et al. Carotid plaque score and intima media thickness as predictors of stroke and mortality in hypertensive patients. Hypertens Res 2013; 36 (10) 902-909
71 Sirimarco G, Amarenco P, Labreuche J. , et al; REACH Registry Investigators. Carotid atherosclerosis and risk of subsequent coronary event in outpatients with atherothrombosis. Stroke 2013; 44 (02) 373-379
72 Tsuda K, Shiiya N, Washiyama N. , et al. Carotid stenosis with impaired brain flow reserve is associated with an increased risk of stroke in on-pump cardiovascular surgery. Interact Cardiovasc Thorac Surg 2018; 27 (01) 75-80
73 Udesh R, Mehta A, Gleason T, Thirumala PD. Carotid artery disease and perioperative stroke risk after surgical aortic valve replacement: a nationwide inpatient sample analysis. J Clin Neurosci 2017; 42: 91-96
74 Alonso-Coello P, Bellmunt S, McGorrian C. , et al. Antithrombotic therapy in peripheral artery disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e669S-e690S
75 Brott TG, Halperin JL, Abbara S. , et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol 2011; 57 (08) 1002-1044