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Threshold for Revascularization in Asymptomatic Carotid Artery Stenosis and Outcomes

  • Kosmas I. Paraskevas
    Correspondence
    Correspondence to: Kosmas I. Paraskevas, MD, PhD, Department of Vascular Surgery, Central Clinic of Athens, 24, Alexander Papagou street, N. Iraklio, 14122 Athens, Greece
    Affiliations
    Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece
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Published:February 18, 2023DOI:https://doi.org/10.1016/j.avsg.2023.02.004
Threshold for Revascularization in Asymptomatic Carotid Artery Stenosis and Outcomes
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Next ArticleRadiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population
      In the study by Sorber et al.,
      • Sorber R.
      • Holscher C.M.
      • Zarkowsky D.S.
      • et al.
      Increased regional market competition is associated with a lower threshold for revascularization in asymptomatic carotid artery stenosis.
      Ann Vasc Surg. 2022; 87: 164-173
      92,243 carotid revascularization procedures were performed for carotid stenosis during a period of nearly 5 years (January 1, 2016 to December 1, 2020). Of these, 57,094 (61.9%) were performed for asymptomatic carotid artery stenosis (ACAS), 37,742 (66.1%) were performed for high-grade (> 80%) stenosis, and 19,352 (33.9%) for 50–80% ACAS. Of the 19,352 patients with 50–80% ACAS, 197 (1.0%) suffered a stroke, while 231 patients suffered a stroke/in-hospital death (1.2%).
      • Sorber R.
      • Holscher C.M.
      • Zarkowsky D.S.
      • et al.
      Increased regional market competition is associated with a lower threshold for revascularization in asymptomatic carotid artery stenosis.
      Ann Vasc Surg. 2022; 87: 164-173
      In contrast, of the 37,742 patients with > 80% ACAS, 313 (0.8%) suffered a stroke and 374 (1.0%) suffered a stroke/in-hospital death.
      • Sorber R.
      • Holscher C.M.
      • Zarkowsky D.S.
      • et al.
      Increased regional market competition is associated with a lower threshold for revascularization in asymptomatic carotid artery stenosis.
      Ann Vasc Surg. 2022; 87: 164-173
      The authors concluded that “among ACAS patients, patients with moderate-grade stenosis had a higher odds ratio of in-hospital stroke or death compared to patients with high-grade stenosis (odds ratio: 1.22; 95% confidence interval 1.03–1.45)”.
      • Sorber R.
      • Holscher C.M.
      • Zarkowsky D.S.
      • et al.
      Increased regional market competition is associated with a lower threshold for revascularization in asymptomatic carotid artery stenosis.
      Ann Vasc Surg. 2022; 87: 164-173
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      References

        • Sorber R.
        • Holscher C.M.
        • Zarkowsky D.S.
        • et al.
        Increased regional market competition is associated with a lower threshold for revascularization in asymptomatic carotid artery stenosis.
        Ann Vasc Surg. 2022; 87: 164-173
        View in Article
        • Abbott A.
        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
        View in Article
        • Paraskevas K.I.
        • Spence J.D.
        • Veith F.J.
        • et al.
        Identifying which patients with asymptomatic carotid stenosis could benefit from intervention.
        Stroke. 2014; 45: 3720-3724
        View in Article

      Article info

      Publication history

      Published online: February 18, 2023

      Publication stage

      In Press Journal Pre-Proof

      Identification

      DOI: https://doi.org/10.1016/j.avsg.2023.02.004

      Copyright

      © 2023 Elsevier Inc. All rights reserved.

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