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(Stroke. 2002;33:2347.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Patient Selection for Carotid Angioplasty and Stenting

Alain Barth, MD

Department of Neurosurgery, University Hospital of Berne, Berne, Switzerland

Claudio Bassetti, MD

Department of Neurology, University Hospital of Zürich, Zürich, Switzerland

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the article by Dietz et al¹ recently published in Stroke. The authors report the clinical results of a consecutive series of 43 patients with symptomatic carotid stenosis treated by angioplasty and stenting. We would like to express concern about the selection of patients for endovascular treatment in this study.

In the title and within the article, the authors emphasize the selection of patients according to the prognostic model of Rothwell et al² for carotid endarterectomy. This model was developed from data gathered in the European Carotid Surgery Trial³ (ECST) to identify the best candidates for surgical treatment as opposed to medical therapy alone. The model included 2 sets of prognostic factors for medical and surgical adverse events and provided a score from 0 to 5 that predicted benefit (4), no significant benefit (>1 to <4), or potential harm (1) of the operation. The conclusion drawn from Rothwell et al was to exclude patients with scores <4 from the operation and to treat them exclusively with prophylactic medical therapy.

The prognostic model was developed from data on patients with 0% to 69% carotid stenosis in the ECST and then tested and validated on 990 ECST patients with 70% to 99% carotid stenosis assigned to surgery (594) or medical therapy alone (396). To the best of our knowledge, the prognostic model has not yet been validated by institutions other than ECST Collaborative Group, especially not by single centers confronted with the selection of individual patients . . . [Full Text of this Article]

Joachim Berkefeld, MD

Institute of Neuroradiology

Matthias Sitzer, MD

Department of Neurology, Johann Wolfgang Goethe-University, Frankfurt am Main, Germany

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