Response to Letter by Ng et al Regarding Article, “Risk of Early Carotid Endarterectomy for Symptomatic Carotid Stenosis”
We thank Drs. Ng, Robless, and Sharma for their interest in our article and their thoughtful comments. Ours was an attempt to assess the risk of early carotid endarterectomy after a symptomatic event in a “real-life” situation. We included data on asymptomatic patients treated in the same interval to provide data regarding complication rates in a low-risk population. We acknowledge the controversy of invasive treatment for asymptomatic carotid artery stenosis. Patients in our series with asymptomatic carotid artery stenosis were selected for treatment by vascular neurologists. In our practice, we consider invasive treatment for patients perceived to be at higher risk of future ipsilateral ischemic events such as those with progressive stenosis on noninvasive studies despite adequate medical therapy, and those with contralateral previous symptomatic carotid artery stenosis or contralateral occlusion. We agree that the data to support this practice are controversial and we await more definitive information on this subject from ongoing multicenter trials on the subject. We concur that investigations on the role of new and evolving technologies to assess embolic potential and cerebral hemodynamic compromise in surgical candidates should continue.
Our study cannot address the learning curve associated with carotid endarterectomy as the surgeons involved in the study have had many years of experience with a large volume of carotid endarterectomies before the period analyzed in our study.
Waleed Brinjikji, BS
Alejandro A. Rabinstein, MD
Giuseppe Lanzino, MD
Mayo Medical School
Department of Neurology
Department of Neurosurgery
Stroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. Include a completed copyright transfer agreement form (available online at http://stroke.ahajournals.org and http://submit-stroke.ahajournals.org).
- © 2011 American Heart Association, Inc.