Treatment of asymptomatic carotid disease with stenting: con.
The landmark trials of the 1980s established a powerful precedent for demanding that "evidence" rather than "intuitive reasoning" should determine practice regarding management of patients with carotid disease. Accordingly, for our opponents to succeed in this debate, they must first demonstrate that there is little remaining confusion regarding the optimal management of asymptomatic carotid disease and then provide compelling evidence that it is now reasonable to offer carotid angioplasty with stenting without the protection of randomized trials. It is our contention that neither can be demonstrated and that the motion cannot be sustained.
Naylor
A Ross
AR
Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK. ross.naylor@uhl-tr.nhs.uk
Bell
Peter R F
PR
D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D016893:Carotid Stenosis / Q000601:surgery / Q000628:therapy*; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D019317:Evidence-Based Medicine; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011474:Prosthesis Design; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome