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(Stroke. 2005;36:1357.)
© 2005 American Heart Association, Inc.

Letters to the Editor

The Risk and Benefit of Endarterectomy In Women With Symptomatic Internal Carotid Artery Disease

John B. Chang, MD Theodore A. Stein, PhD

Long Island Vascular Center, Roslyn, NY

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 recent article by Alamowitch et al¹ on the risk and benefit of endarterectomy in women with symptomatic internal carotid artery disease. Whereas women and men with 70% symptomatic stenosis had a similar benefit from a carotid endarterectomy, women with 50% to 69% stenosis did not benefit from the procedure. The 30-day perioperative risk of death was 2.3% in women and 0.8% in men, and the combined risk of stroke and death was 7.6% in women and 5.9% in men. Because the data for this study were taken from the North American Symptomatic Carotid Endarterectomy Trial (NASCET),² the conclusions must be understood with the design of the NASCET study that involved 50 clinical centers in North America. Patients with high-grade stenosis were enrolled and randomized from January 1988 to February 1991. The parallel study of patients with medium-grade stenosis (30% to 69%) was continued until December 1996.³ Though patients older than age 80 years were excluded before February 1991 for both the moderate and severe parallel studies, older patients were included in the second phase of the NASCET study.

One concern in interpreting the current study is that the moderate stenosis group included older patients than the severe stenosis group, and that the benefit of carotid endarterectomy may be less, in part, from the older age of some patients with moderate carotid stenosis. Because the surgical technique was left to the discretion of the surgeon, it is unclear how different operative techniques affected . . . [Full Text of this Article]

Michael Eliasziw, PhD

Department of Community Health Sciences, and Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada

Sonia Alamowitch, MD

Stroke Unit, Department of Neurology, Tenon Hospital, AP-HP, Paris, France

Henry J.M. Barnett, MD

The John P. Robarts Research Institute, London, Ontario, Canada.