Shared decision-making (SDM) involves patients and clinicians working together to identify a mutually agreeable clinical outcome that reflects the patients’ values and motivations [1]. SDM has been shown to improve cognitive and behavioral outcomes, self-determination, and patient satisfaction [2]. These discussions are frequently augmented with the use of decision aids. Decision aids are standardized tools to help providers present information to patients, and have been shown to improve patient understanding and reduce decisional conflict [[2], [3], [4], [5]].

Carotid stenosis is particularly well-suited for SDM, as there are a myriad of therapeutic options, both medical and surgical [6,7]. These may include optimal medical therapy, carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), or transfemoral carotid artery stenting, each with overlapping risks and benefits that can vary over time [6,7]. For asymptomatic patients, a treatment decision involves additional complexity, as patients often require education about incidental findings and their implications in order to fully understand the nuanced tradeoffs involved [8].

However, despite the benefits and minimal risks, decision aids in vascular surgery are clinically underutilized, and to date, there is no widely used validated decision aid for patients with carotid artery disease [9,10]. In 2023, changes to the Medicare National Coverage Determination (NCD) for carotid stenting require documentation of an SDM interaction between the provider and patient as a requirement for reimbursement [11]. Therefore, our objective is to determine whether, for patients with carotid artery disease, a decision support tool, as compared to a standard preoperative discussion, improves patient understanding, reduces decisional conflict, and is found to be a useful adjunct to a clinic visit. We also intend to summarize the specific preferences important to patients with carotid artery disease and the features of a decision support tool that patients with carotid disease find most useful. Our goal is to inform the development of a widely used, validated decision aid for patients with carotid artery stenosis.