Medical treatment of carotid endarterectomy patients requires attention.
OBJECTIVE
The benefits of prophylactic carotid endarterectomy (CEA) together with best medical treatment (BMT) are well-established. Early initiation of proper medical treatment reduces the risk of new strokes as waiting periods for CEA operation can be considerably long. We investigated: (1) preoperative medical treatment of CEA patients at our hospital and (2) how well the present medical treatment coheres with national and international secondary prevention guidelines and other CEA cohorts.


METHODS
A retrospective study cohort of 135 consecutive patients planned for CEA in a tertiary center because of symptomatic (n = 100) or asymptomatic (n = 35) carotid artery stenosis during a 14-month period (2007-2008).


RESULTS
One hundred and twenty-six of 135 (93.3%) patients received antiplatelet therapy at the time of surgery, 125/135 (92.6%) were on statin, and 121/135 (89.6%) used antihypertensive medications. Ten of the 100 symptomatic patients had recurrence or progression in their ischemic symptoms while waiting for the operation, with a median time of 8.5 days (range 1-30 days).


CONCLUSIONS
Carotid artery stenosis patients are considered high-risk patients regardless of symptomatology. The high proportion of medication use exceeds the use in the past proof-of-concept randomized controlled trials on the benefit of CEA+BMT over BMT. Nevertheless, there is room for improvement.
Department of Neurology, Helsinki University Central Hospital, Finland. tiina.sairanen@hus.fi
Tiina
T
Sairanen
Pirkka
P
Vikatmaa
Juha-Matti
JM
Lindholm
Maarit
M
Venermo
Mauri
M
Lepäntalo
Turgut
T
Tatlisumak
D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019985:Benchmarking / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000601:surgery; D018450:Disease Progression; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011300:Preoperative Care / Q000379:methods*; D057234:Preoperative Period; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors