A balanced approach is warranted for patients with asymptomatic carotid stenosis

We thank Dr Abbott for her interest in our work.1 We do not agree with the claim that the nine clinical and imaging markers of high future stroke risk despite medical intervention proposed by the European Society for Vascular Surgery (ESVS) guidelines2 can be used to justify an invasive procedure for “just about all individuals with 60-99% asymptomatic carotid stenosis (ACS)”.3 These markers define specific ACS patient subgroups. Furthermore, the ESVS guidelines only provided a Class IIa, Level of Evidence B, a careful recommendation with a mention that “CEA should be considered” (not “ CEA is recommended”) for these subgroups, thus highlighting the uncertainty in their management.

Source: Journal of Vascular Surgery - March 22, 2021 Category: Surgery Authors: Kosmas I. Paraskevas, Jean-Baptiste Ricco, Richard P. Cambria, Enrico Ascher, Frank J. Veith, Ali F. AbuRahma Tags: Letter to the Editor Source Type: research