carotid endarterectomy in the prevention of stroke

[DNASplicer]

I thought that if a pt was asymptomatic the benefit of carotid endarterectomy was minimal. (I recall reading studies along these lines when I was on surgery.) Therefore, just used ASA and reduction of atherosclerotic RF.

Am I off base here? There was a usmleWorld question that states 60-90% steniss is an indication for surg...

thanx

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[VincentAdultman]

I thought that if a pt was asymptomatic the benefit of carotid endarterectomy was minimal. (I recall reading studies along these lines when I was on surgery.) Therefore, just used ASA and reduction of atherosclerotic RF.

Am I off base here? There was a usmleWorld question that states 60-90% steniss is an indication for surg...

thanx

Yea UW is right...in general 70% stenosis is the threshold for CEA...even in asymptomatic pts.

 

[DNASplicer]

Thanx. Must look this up then... was too lazy before.

 

[lattimer13]

pt gets CEA if 50% stenosis and symptomatic, or 60-70% stenosis and asymptomatic (depends who you talk to, the vascular surgeon i did my 3rd year surg rotation said 60%).

 

[DNASplicer]

yes, I believe it's controversial. Now that I've looked, I have seen 60% in asympt pt and 70% and I have seen different numbers for men and women, but that's real world. Step 2 I don't think will be so controversial. I will be choosing CEA in asympt pt with 60% stenosis.

splicer

 

[dividedsky]

from the 2007 Boards & Wards:

Symptomatic pt: (1) >70% stenosis (2) h/o multiple TIAs (3) previous CVA

Asymptomatic pt: >75% stenosis

B&Ws even says it controversial though

yes, I believe it's controversial. Now that I've looked, I have seen 60% in asympt pt and 70% and I have seen different numbers for men and women, but that's real world. Step 2 I don't think will be so controversial. I will be choosing CEA in asympt pt with 60% stenosis.

splicer