Foreword

With the mandate for value-based decision-making in health care, the need for evidence-based guidelines to direct decisions regarding the appropriateness of our interventions continues to grow. There is no better model for development of such approaches than the series of well-designed clinical studies directed at the management of extracranial carotid artery disease. Although some questions remain, researchers in this field, using predominantly randomized clinical trials, have developed a robust basis for decision making and standardized care pathways. In this issue of Current Problems in Surgery, Drs C. Keith Ozaki, Piotr Sobieszcyk, and Edwin Gravereaux from Brigham and Women׳s Hospital; Dr Karen Ho from Northwestern Feinberg School of Medicine; and Dr James McPhee from the Boston University School of Medicine share their expertise in a masterful perspective on this topic entitled, “Evidence-Based Carotid Artery Interventions for Stroke Risk Reduction.” They begin with an introduction including the epidemiology, a historical overview, and a discussion of the challenges ahead. A subsequent section covers medical therapies including antiplatelet agents, anticoagulants, beta blockers, 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors, and antihypertensives. They move on to thorough discussions of carotid artery interventions, including traditional open operation and carotid stenting. Each of the clinical trials is discussed in appropriate detail. Their discussio...

Source: Current Problems in Surgery - February 12, 2014 Category: Surgery Authors: Stanley W. Ashley Source Type: research