Findings from a retrospective analysis delivered at the recent European Society for Vascular Surgery (ESVS) annual meeting (Sept. 24–27) in Kraków, Poland, provide evidence that—for symptomatic carotid artery stenosis patients—endarterectomy “remains a useful and relevant intervention in the era of improving medical therapy.”
Presenter Sashini Iddawela, MBBS, from University College London Hospital NHS Trust in London, England, noted that urgent carotid endarterectomy (CEA) is currently the first-line recommendation for symptomatic, significant carotid stenosis. There is also speculation that symptomatic stenosis could be substantially reduced thanks to today’s advances in optimal medical therapy (OMT) and anti-major cardiovascular event (MACE) medications.
Iddawela and her colleague Daryll Baker, BMBCh, a consultant vascular surgeon at Royal Free London NHS Foundation Trust, undertook a study in an effort to determine whether or not patients undergoing CEA were already on OMT prior to their index admission. They performed a retrospective analysis of 124 patients receiving urgent CEA following development of a stroke or transient ischemic attack between 2021 and 2023. Overall, 36 patients (29%) were on a combination of an antiplatelet, antihypertensive and statin during their index presentation. According to the researchers, there was no significant difference between the proportion of patients on antiplatelets, antihypertensives or statins pre- versus post-CEA. However, patients with ischemic heart disease, diabetes or hypertension were observed as being significantly more likely to be on OMT.
This led to the conclusion that patients undergoing CEA are generally multimorbid and more likely to be on risk-modifying therapy at their index presentation. Thus, the researchers state that CEA should still be considered a useful intervention in these patients.
