Symptomatic Patients and Stroke Risk Before Carotid Endarterectomy or Stenting

Abstract

Congratulations to Fisch et al. for providing additional evidence that the risk of recurrent stroke in symptomatic patients with carotid stenosis has fallen with medical intervention alone since the randomised trials of carotid endarterectomy (CEA) versus medical intervention were conducted decades ago. 1 Fisch U. von Felten S. Wiencierz A. Jansen O. Howard G. Hendrikse J. et al. Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials. Eur J Vasc Endovasc Surg. 2021; 61: 881-887 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ,2 Shahidi S. Owen-Falkenberg A. Gottschalksen B. Ellemann K. Risk of early recurrent stroke in symptomatic carotid stenosis after best medical therapy and before endarterectomy. Int J Stroke. 2016; 11: 41-51 Crossref PubMed Scopus (26) Google Scholar Editor's Choice – Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled TrialsEuropean Journal of Vascular and Endovascular SurgeryVol. 61Issue 6PreviewCurrent guidelines recommending rapid revascularisation of symptomatic carotid stenosis are largely based on data from clinical trials performed at a time when best medical therapy was potentially less effective than today. The risk of stroke and its predictors among patients with symptomatic carotid stenosis awaiting revascularisation in recent randomised controlled trials (RCTs) and in medical arms of earlier RCTs was assessed. Full-Text PDF Open AccessResponse to ‘Re. Risk of Stroke before Revascularisation in Patients with Symptomatic Carotid Stenosis: A Pooled Analysis of Randomised Controlled Trials’European Journal of Vascular and Endovascular SurgeryVol. 62Issue 5PreviewWe thank Prof. Abbott for her interest in our paper.1 We agree fully that the benefit of carotid endarterectomy (CEA) for symptomatic carotid stenosis in randomised trials depends on the patient characteristics that Prof. Abbott listed. However, our study focused on the risk of stroke before revascularisation among patients with symptomatic carotid stenosis in clinical trials. Of note, the risk of early recurrent stroke immediately after the first ischaemic event as reported in contemporary observational studies is higher than the corresponding risk following randomisation as measured in the trials we investigated. Full-Text PDF