The urgent need for contemporary clinical trials in patients with asymptomatic carotid stenosis.
Asymptomatic extracranial internal carotid artery atherosclerotic stenosis increases with age and is more common in men. Studies performed more than 2 decades ago showed that carotid endarterectomy reduced the rate of stroke in carefully selected patients with asymptomatic carotid stenosis compared with medical therapy in the long term. Those trials were completed more than 20 years ago and with advances in the treatment of atherosclerotic disease, the question has been raised to as to whether endarterectomy is still of value for patients with asymptomatic narrowing. Perioperative risk of carotid revascularization procedures has also declined. Due to improvements in both medical and surgical treatments for carotid artery stenosis, it is timely to reevaluate the efficacy of carotid intervention relative to medical treatment for patients with asymptomatic stenosis.
From the University of Miami Miller School of Medicine (S.C.), FL; Medical University of South Carolina (M.C.), Charleston; Mayo Clinic (R.D.B.), Rochester, MN; University of Maryland School of Medicine (B.K.L.), Baltimore; and Mayo Clinic (J.F.M.), Jacksonville, FL. schaturvedi@med.miami.edu.
Seemant
S
Chaturvedi
From the University of Miami Miller School of Medicine (S.C.), FL; Medical University of South Carolina (M.C.), Charleston; Mayo Clinic (R.D.B.), Rochester, MN; University of Maryland School of Medicine (B.K.L.), Baltimore; and Mayo Clinic (J.F.M.), Jacksonville, FL.
Marc
M
Chimowitz
From the University of Miami Miller School of Medicine (S.C.), FL; Medical University of South Carolina (M.C.), Charleston; Mayo Clinic (R.D.B.), Rochester, MN; University of Maryland School of Medicine (B.K.L.), Baltimore; and Mayo Clinic (J.F.M.), Jacksonville, FL.
Robert D
RD
Brown
From the University of Miami Miller School of Medicine (S.C.), FL; Medical University of South Carolina (M.C.), Charleston; Mayo Clinic (R.D.B.), Rochester, MN; University of Maryland School of Medicine (B.K.L.), Baltimore; and Mayo Clinic (J.F.M.), Jacksonville, FL.
Brajesh K
BK
Lal
From the University of Miami Miller School of Medicine (S.C.), FL; Medical University of South Carolina (M.C.), Charleston; Mayo Clinic (R.D.B.), Rochester, MN; University of Maryland School of Medicine (B.K.L.), Baltimore; and Mayo Clinic (J.F.M.), Jacksonville, FL.
James F
JF
Meschia
D000818:Animals; D016893:Carotid Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D002986:Clinical Trials as Topic; D006801:Humans
Circ Cardiovasc Interv. 2009 Jun;2(3):159-66
20031712
Clin Neuroradiol. 2017 Mar;27(1):7-13
26063003
J Vasc Surg. 2013 Jul;58(1):112-8
23478502
Eur J Vasc Endovasc Surg. 2009 Mar;37(3):262-71
19058982
Surgeon. 2015 Feb;13(1):34-43
25439170
Stroke. 2013 Oct;44(10):2957-8
23943215
Stroke. 2009 Oct;40(10):3180-5
19644063
Stroke. 2014 Aug;45(8):2366-71
24994719
Neurology. 2005 Sep 27;65(6):794-801
16186516
J Am Coll Cardiol. 2013 Apr 2;61(13):1379-87
23490041
Arch Neurol. 2010 Feb;67(2):180-6
20008646
Ann Intern Med. 2014 Sep 2;161(5):336-46
25004169
Stroke. 2011 Sep;42(9):2672-713
21778438
N Engl J Med. 1993 Jan 28;328(4):221-7
8418401
Neurology. 1994 Jun;44(6):1046-50
8208397
J Vasc Surg. 2011 Sep;54(3):e1-31
21889701
JAMA. 1995 May 10;273(18):1421-8
7723155
Stroke. 2008 Dec;39(12):3297-302
18845807
Stroke. 2010 Jan;41(1):e11-7
19926843
N Engl J Med. 2016 Mar 17;374(11):1087-8
26890473
J Am Coll Cardiol. 2014 Aug 19;64(7):722-31
25125305
J Am Coll Cardiol. 2015 Mar 24;65(11):1134-43
25790886
Stroke. 2011 Jul;42(7):2080-5
21659637
Stroke. 2014 Dec;45(12):3720-4
25358698
Stroke. 2015 Mar;46(3):757-61
25613307
Stroke. 2016 Feb;47(2):542-7
26670084
Stroke. 2014 Dec;45(12):3754-832
25355838
Stroke. 1991 Dec;22(12):1485-90
1962321
Stroke. 2004 Oct;35(10):2425-7
15331794
Neurology. 2013 Jun 11;80(24):2258-68
23751919
Neurology. 2000 Jul 12;55(1):30-4
10891899
Stroke. 2014 Jul;45(7):2160-236
24788967
Neurobiol Aging. 2009 Aug;30(8):1177-83
18077061
J Vasc Surg. 2007 Feb;45(2):289-96; discussion 296-7
17264005
J Vasc Surg. 2015 Feb;61(2):519-532.e1
25498191
N Engl J Med. 2010 Jul 1;363(1):11-23
20505173
Stroke. 2011 Mar;42(3):734-9
21233473
Stroke. 2009 Oct;40(10):e573-83
19696421
Stroke. 2009 Apr;40(4):1105-13
19246704
N Engl J Med. 1998 Nov 12;339(20):1441-7
9811920
Lancet. 2010 Sep 25;376(9746):1074-84
20870099
Stroke. 2013 Apr;44(4):1002-7
23404720
Lancet. 2004 May 8;363(9420):1491-502
15135594
J Am Heart Assoc. 2016 Feb 22;5(2):
26903005
Circulation. 2016 May 24;133(21):2103-22
27067230
J Am Coll Cardiol. 2011 Feb 22;57(8):1002-44
21288680
Am J Epidemiol. 2013 Sep 15;178(6):974-83
23851579
Neurology. 2013 Jun 4;80(23):2086-7
23624564
Neurology. 2015 Jul 28;85(4):365-72
26115734
Stroke. 2014 Mar;45(3):e40-1
24503669
Stroke. 2015 Sep;46(9):2562-7
26251251
Stroke. 2008 Nov;39(11):3116-27
18723423
J Vasc Surg. 2013 Feb;57(2):303-8
23265585
Stroke. 1998 Jun;29(6):1099-105
9626278