Zulfiqar Rana, MD, MPH, FACP

From J Watch: These recommendations concur with recently released guidelines on primary and secondary stroke prevention. The main message about revascularization for symptomatic carotid stenosis is that stenting should be avoided in older patients (e.g., aged 70) but might be as safe as endarterectomy in younger patients. However, a more important question is how either revascularization technique compares with intensive contemporary medical therapy, particularly in asymptomatic patients. As evidenced by the number of recommendations that are based on consensus in the absence of definitive evidence, opportunities for further research abound (e.g., the “imperfect correlation” between severity of carotid stenosis and ischemic events, methods to improve diagnostic accuracy, the effectiveness of carotid surgery in women). Large gaps in knowledge about vertebral arterial disease will be difficult to fill because of its relative infrequency compared with carotid artery disease.

Guidelines: Extracranial Carotid and Vertebral Artery Disease – Cardiology.