The New 2023 European Society for Vascular Surgery (ESVS) Carotid Guidelines – The European Perspective

The 2023 European Society for Vascular Surgery (ESVS) clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease1 is a comprehensive document that expands considerably the earlier (2017) ESVS Carotid and Vertebral Guidelines.2 The 2023 Guidelines include a total of 133 recommendations, of which 84 remained unchanged, 11 have been regraded since the previous Guidelines,2 and 38 are new.1 Importantly, the new Guidelines provide answers to a number of previously “unanswered questions”, such as which patients are “high risk” for carotid endarterectomy (CEA) or carotid artery stenting (CAS), if there is an association between asymptomatic carotid stenosis (ACS) and cognitive decline, if this can be reversed/prevented by CEA/CAS, as well as other important issues.