Response to Letter by Weimar and Knipp Regarding Article, “Patients With Severe Asymptomatic Carotid Artery Stenosis Do Not Have a Higher Risk of Stroke and Mortality After Coronary Artery Bypass Surgery”
Thank you for the opportunity to reply to the letter written by Weimar and Knipp.1 The standard of care for patients undergoing coronary artery bypass grafting with concomitant, severe, asymptomatic carotid artery stenosis has not yet been defined. Although the American College of Cardiology/American Heart Association guidelines recommend prophylactic carotid endarterectomy to reduce the risk of perioperative stroke, the evidence for this has been based on studies that demonstrated the benefit of carotid endarterectomy over medical therapy as a stroke-reducing measure in patients with carotid artery stenosis.2,3 Our study has added to the growing body of predominantly retrospectively derived evidence that, in patients with asymptomatic severe carotid artery stenosis undergoing coronary artery bypass grafting, routine prophylactic carotid endarterectomy cannot be justified.4,5 However, we accept that currently available data lack the vigor of randomized trials and, as a consequence, welcome the aforementioned randomized study.
Washington Hospital Center
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).
- © 2012 American Heart Association, Inc.
- Weimar C,
- Knipp SC
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effects of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Eng J Ned. 1998;325:445–453.
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