Regarding an Apparently High Stroke Rate in Patients With Medically Managed Asymptomatic Carotid Stenosis at an Academic Center in the Southeastern United States

We respectfully disagree with Weiner et al and advise that it is premature to give up on current best non-invasive medical intervention (lifestyle coaching and medication) alone for patients with asymptomatic carotid stenosis (ACS).(1) Weiner et al reported an average annual ipsilateral 'stroke' rate of 2.9% (10 ipsilateral strokes, in 173 patients with>70% stenosis over 2 years). This is just a little more than for non-surgically managed patients in the Asymptomatic Carotid Atherosclerosis Study (2.3%/year in patients with 60-99% ACS) and significantly more than in the most recently published quality studies of non-invasively managed patients with>50-75% ACS (approximately 0.8%/year).(2-4)
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Correspondence Source Type: research