Research Prioritization Topic Brief Topic 4: “Carotid Artery Disease” Comparative effectiveness of medical and surgical treatment options of patients with asymptomatic carotid artery stenosis.

PCORI Scientific Program Area: Assessment of Prevention, Diagnosis and Treatment Options Dr. Gillian Sanders Schmidler, PhD, and Team The Duke Clinical Research Institute April 16, 2013

PCORI Topic Brief: Assessment of Prevention, Diagnosis and Treatment Options

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Criteria Introduction Overview/definition of topic

Brief Description DESCRIPTION OF CONDITION Overview • The carotid arteries, which carry blood to the brain, are prone to blockage from arteriosclerosis (thickening/hardening of the arteries). Atherosclerotic plaque in the carotid arteries can lead to ischemic strokes or transient ischemic attacks (TIAs). • The risk of stroke related to carotid artery disease is higher with: o Higher degrees of stenosis (narrowing of the carotid artery) o Neurologic symptoms o Evidence of asymptomatic cerebral embolism or presence of ulcerations of carotid artery • Peripheral vascular disease and ischemic heart disease are common comorbid conditions. Screening/Diagnosis • Carotid stenosis can be identified through diagnostic evaluation: o In persons with neurologic symptoms o By hearing a neck bruit (abnormal sound) o Via screening tests (Doppler ultrasound)

Relevance to patient-centered outcomes

Burden on Society Recent incidence and prevalence in populations and subpopulations

Treatment • Three main treatments are used to prevent stroke in patients with carotid artery disease: (1) medical therapy (using various drugs) for risk factor reduction, (2) carotid endarterectomy (CEA) or, more recently, (3) percutaneous carotid artery angioplasty and stenting (CAS). CEA and CAS are two different types of revascularization procedures. SYMPTOMS/OUTCOMES • Neurologic symptoms sometimes last