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carotid endarterectomy in the prevention of stroke

DNASplicer

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    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
     

    VincentAdultman

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      DNASplicer said:
      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.
       
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      DNASplicer

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        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

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          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


          DNASplicer said:
          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
           
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