Summary: \u201cTime to Change the Guidelines for Carotid Endarterectomy?\u201d
\nSource: Medscape Medical News.
\nPublished: April 28, 2025
\nOriginal Study Publication: The Lancet Neurology, April 16, 2025<\/p>\n
Key Findings in Bullet Points: Summary: \u201cTime to Change the Guidelines for Carotid Endarterectomy?\u201d Source: Medscape Medical News. Published: April 28, 2025 Original Study Publication: The Lancet Neurology, April 16, 2025 Key Findings in Bullet Points: 1. OMT vs. Surgery: Optimized medical therapy (OMT) was found to be as effective as carotid endarterectomy (CEA) in preventing stroke in the majority […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-6730","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6730","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/comments?post=6730"}],"version-history":[{"count":1,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6730\/revisions"}],"predecessor-version":[{"id":6731,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/posts\/6730\/revisions\/6731"}],"wp:attachment":[{"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/media?parent=6730"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/categories?post=6730"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/jordan-cardiac.org\/en\/wp-json\/wp\/v2\/tags?post=6730"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\n1. OMT vs. Surgery: Optimized medical therapy (OMT) was found to be as effective as carotid endarterectomy (CEA) in preventing stroke in the majority of patients with carotid artery stenosis.
\n2. CAR Score Introduction: The new Carotid Artery Risk (CAR) score, using updated stroke risk data, suggests that up to 75% of current CEA candidates could be managed with OMT alone.
\n3. Study Population:
\n\u2022 429 patients with \u226550% carotid stenosis.
\n\u2022 Median age: 72 years; 69% male.
\n\u2022 40% symptomatic, 60% asymptomatic.
\n4. Treatment Arms:
\n\u2022 Patients received either OMT alone or OMT + CEA.
\n\u2022 OMT included strict lipid, blood pressure, antithrombotic, lifestyle, and diabetic management.
\n5. Primary Endpoint: A composite of periprocedural death, fatal\/nonfatal stroke or MI, and silent brain infarctions.
\n6. Outcome Analysis – Win Ratio Method:
\n\u2022 77.3% of patient pairs were \u201cties\u201d (similar outcomes).
\n\u2022 OMT-only \u201cwins\u201d: 11.4% vs. 11.3% for OMT+CEA.
\n\u2022 Win ratio: 1.01 (95% CI: 0.60\u20131.70; P = 0.97) \u2013 showing no clear advantage for surgery.
\n7. Implication: Most patients with low predicted 5-year stroke risk (CAR score <20%) may safely avoid surgery.
\n8. Subgroup Analysis: No significant outcome differences by age, sex, diabetes, hypertension, or degree of stenosis.
\n9. Limitations:
\n\u2022 2-year follow-up only (long-term outcomes pending).
\n\u2022 CAR score not yet independently validated.
\n\u2022 COVID-19 disrupted follow-up imaging.
\n\u2022 Modest sample size, limiting power for subgroup detection.
\n10. Expert Opinions:
\n\u2022 Martin Brown, MD: Advocates updating guidelines to reflect modern therapy effectiveness.
\n\u2022 Paul Nederkoorn, MD: Emphasizes potential impact on reducing surgical risks and healthcare costs.
\n\u2022 Steven Messe, MD: Notes 2-year follow-up may not be sufficient; long-term benefits of CEA might take longer to emerge.
\n\u2022 Commentators (Ho & Hankey): Cautiously optimistic but call for more robust data.
\nhttps:\/\/click.mail.medscape.com\/?qs=3ee7fdc169c577652fed27671ec2ff45fee82688576e61970c3fa4722092acf4103eae52395ce9c8d614f213cd4f3c41ece4da5654fa23ca5c90f28ac713da96<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"