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Carotid revascularization is worthwhile only when perioperative morbidity and mortality are low and when patients are destined to live long enough to accrue benefit. However, two U.S. studies raise questions about patient selection for this procedure.
In one study, researchers collected data on perioperative and longer-term outcomes for 22,500 Medicare patients (mean age, 76) who underwent carotid stenting from 2005 to 2009. The burden of comorbidities was high, and carotid stenosis was asymptomatic in about half of patients.
Outcomes for patients with asymptomatic stenosis were as follows:
Thirty-day rates of death, stroke/transient ischemic attack (TIA), and myocardial infarction were 1.2%, 2.3%, and 2.2%, respectively.
Two-year rates of deat…