Comparing Carotid Endarterectomy with Medical Therapy for Asymptomatic Carotid Stenosis

In two randomized trials that were initiated about 30 years ago, carotid endarterectomy showed a modest 5-year drop in stroke among patients with asymptomatic carotid stenosis. However, because medical management of vascular risk factors has improved considerably since then, the role of invasive treatment for asymptomatic stenosis is unclear. Investigators used national U.S. Veterans Affairs and Medicare data in a comparative effectiveness study of ≈5200 patients (mean age, 74) with asymptomatic carotid stenosis who received carotid revascularization or initial medical therapy between 2005 and 2009. Patients were matched for a wide range of clinical and demographic variables. The study excluded patients with stroke or transient ischemic att…