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Old 06-01-2011
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Question Indication of Carotid Endarterectomy

Symptomatic or Asymptomatic (Man or Woman) : we always do CEA if stenosis 70-99%

could anyone confirm?
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Old 06-01-2011
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Originally Posted by docoftheworld View Post
Symptomatic or Asymptomatic (Man or Woman) : we always do CEA if stenosis 70-99%

could anyone confirm?
Yes the greatest mortality benefit for CEA is for stenosis more than 70 percent. Anything less than that, the guidelines are not that clear so don't select CEA when less than 70 percent stenosis.
Angioplasty has no mortality benefit proven for less than 70 percent stenosis
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right, my main concern to make sure:

if it is man or woman, sympto or not symto ) is there any difference in those 4 combinations?
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right, my main concern to make sure:

if it is man or woman, sympto or not symto ) is there any difference in those 4 combinations?
Yes I don't think there is a difference. We do CEA in all if its more than 70 percent stenosis
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CEA in asymptomatic patients is questionable! Benefit is comparable to the medical treatment.

Here is one study

http://stroke.ahajournals.org/cgi/co...rt/41/12/e604-

The authors have studied the contemporary results of carotid endarterectomy (CEA) for 5009 asymptomatic carotid stenosis (ACS) identified in the National Surgical Quality Improvement Program database. They have found that the perioperative stroke, death, and myocardial infarction outcome rates are 0.96%, 0.56%, and 0.22%, respectively. The authors have combined the 0.96% perioperative stroke rates with the 5-year stroke risk after CEA from the Asymptomatic Carotid Surgery Trial2 and have found that the annual stroke rate is approximately 1%. They have concluded that the contemporary stroke rates with CEA are similar with the best medical management for ACS from the Second Manifestations of Arterial Disease Study, that is, 0.8% annual risk of stroke
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CEA in asymptomatic patients is questionable! Benefit is comparable to the medical treatment.
Whats is the standard medical treatment, if not going for CEA
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perhaps aspirin and statins
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Whats is the standard medical treatment, if not going for CEA
Here is a piece of evidence from Lancet.

Basically life style changes (particularly stop smoking) and triple medical therapy (lipid lowering, antihypertensive, antiplatelets) we can say are the standard medical treatment.



The Lancet, Volume 377, Issue 9760, Page 123, 8 January 2011
<Previous Article|Next Article>
doi:10.1016/S0140-6736(11)60015-9Cite or Link Using DOI

Best medical treatment for a symptomatic carotid artery stenosis

Original Text
Kosmas I Paraskevas a, Dimitri P Mikhailidis b, Frank J Veith c d

The Asymptomatic Carotid Surgery Trial (ACST-1; Sept 25, p 1074)1 showed a reduced 10-year stroke risk for patients undergoing carotid endarterectomy (CEA) versus no intervention. Use of antiplatelet, anticoagulant, antihypertensive, and lipid-lowering drugs was similar between the two groups, although use of lipid-lowering drugs increased from about 10% in 1993 to more than 80% in 2003. A subgroup analysis of patients on lipid-lowering therapy also showed a reduced 10-year stroke risk for CEA versus no intervention (76% vs 134%, respectively; gain 58%, 95% CI 2196; p=0002).1


Accumulating evidence suggests that current best medical treatment alone is sufficient for asymptomatic carotid stenosis and that no intervention (ie, CEA or carotid artery stenting [CAS]) is required.24 Best medical treatment includes lifestyle modification (smoking cessation, exercise, weight loss), blood pressure control, and antiplatelet and high-dose statin therapy.2, 3
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the matter is now settled
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