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Regarding an Apparently High Stroke Rate in Patients With Medically Managed Asymptomatic Carotid Stenosis at an Academic Center in the Southeastern United States

Published:September 20, 2022DOI:https://doi.org/10.1016/j.avsg.2022.08.017
      We respectfully disagree with Weiner et al and advise that it is premature to give up on current best non-invasive medical intervention (lifestyle coaching and medication) alone for patients with asymptomatic carotid stenosis (ACS).(
      • Weiner S.
      • Benton M.H.
      • Guraziu B.
      • et al.
      High Stroke Rate in Patients With Medically Managed Asymptomatic Carotid Stenosis at an Academic Center in the Southeastern United States.
      ) Weiner et al reported an average annual ipsilateral 'stroke' rate of 2.9% (10 ipsilateral strokes, in 173 patients with >70% stenosis over 2 years). This is just a little more than for non-surgically managed patients in the Asymptomatic Carotid Atherosclerosis Study (2.3%/year in patients with 60-99% ACS) and significantly more than in the most recently published quality studies of non-invasively managed patients with >50-75% ACS (approximately 0.8%/year).(
      Executive Committee for the Asymptomatic Carotid Atherosclerosis Study
      Endarterectomy for asymptomatic carotid artery stenosis.
      ,
      • Abbott A.L.
      Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis.
      ,
      • Abbott A.L.
      • Silvestrini M.
      • Topakian R.
      • et al.
      Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice.
      )

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      References

        • Weiner S.
        • Benton M.H.
        • Guraziu B.
        • et al.
        High Stroke Rate in Patients With Medically Managed Asymptomatic Carotid Stenosis at an Academic Center in the Southeastern United States.
        Annals Vasc Surg. 2022;
        • Executive Committee for the Asymptomatic Carotid Atherosclerosis Study
        Endarterectomy for asymptomatic carotid artery stenosis.
        JAMA. 1995; 273: 1421-1428
        • Abbott A.L.
        Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis.
        Stroke. 2009; 40: e573-e583
        • Abbott A.L.
        • Silvestrini M.
        • Topakian R.
        • et al.
        Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice.
        Front Neurol. 2017; 8: 537
        • Abbott A.L.
        Extra-Cranial Carotid Artery Stenosis: An Objective Analysis of the Available Evidence.
        Front Neurol. 2022 Jun 21; 13739999