Transatlantic differences in management of carotid stenosis: BRIDGing the gap in stroke management (BRIDGE) project

Clotilde Balucani, Vanessa Arnedo, Jeremy Weedon, Didier Leys, Jean Louis Mas, Martin Brown, James C. Grotta, Nicole R. Gonzales, Werner Hacke, Thomas Brott, Steven R. Levine

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background and Purpose: Management of carotid stenosis remains controversial despite several trials evaluating carotid endarterectomy (CEA) and carotid angioplasty/stenting (CAS). We compared attitudes in the management of carotid stenosis between selected experts within Europe and North America. Methods: A 3-phase Delphi survey was e-mailed to select stroke experts from Europe (n = 390) and North America (n = 289). Those completing the initial survey were shown all responses after each survey round. Consensus was defined as ≥ 80% agreement. Results: For phases 1, 2, and 3, response rates were 32%, 62%, and 73%, respectively. Overall, 100 (15%) of 679 participated in all 3 phases, 19% Europeans versus 9% North Americans (P =.0007). The European group reached consensus in 6 of 15 statements; The North American group reached consensus in 4 of 15. Ninety percentage of Europeans versus 70% of North Americans (P =.017) stated CEA is superior to CAS for symptomatic carotid stenosis. This difference was not significant in the final model (adjusted odds ratio: 3.72 [95% confidence interval: 0.95- 14.5]). Sixty-nine percentage of North Americans agreed there is a stronger indication for CAS over CEA in patients younger than 65 years for symptomatic carotid stenosis, whereas 55% of Europeans (P =.023) disagreed. For asymptomatic carotid stenosis, when asked how likely they would recommend CAS, 62% North Americans said “sometimes” versus 60% of Europeans said “never” (P =.06). Conclusion: The majority of North American and European respondents did not consider the 2 procedures equivalent and seemed to indicate that CEA was preferred for the management of carotid stenosis. These findings need to be further explored to help establish evidence-based guidelines.

Original languageEnglish (US)
Pages (from-to)113-123
Number of pages11
Issue number3
StatePublished - Jul 2018


  • Carotid artery diseases
  • Carotid stenosis
  • Cerebrovascular disorders
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology


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