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Invited Critique
Oct 2011

Should Patients With Chronic Renal Insufficiency Undergo Carotid Intervention?Comment on “Influence of Chronic Renal Insufficiency on Outcomes Following Carotid Revascularization”

Author Affiliations

Author Affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, Charleston, West Virginia.

Arch Surg. 2011;146(10):1141-1142. doi:10.1001/archsurg.2011.256

When analyzing the findings of this study,1 the following facts must be kept in mind. Chronic renal insufficiency (CRI) is associated with advanced multiple vascular pathologies affecting various systems, eg, coronary artery disease, cerebrovascular disease, and peripheral arterial disease, which may affect the operative outcome. Several studies have called into question the best treatment for patients with carotid stenosis concomitant with chronic renal failure, showing increased morbidity and mortality after carotid endarterectomy. Several other studies have only shown differences when patients are separated into mild (creatinine level of 1.6-2.9 mg/dL [to convert to micromoles per liter, multiply by 88.4]) vs severe (creatinine level of ≥3 mg/dL) CRI, with increased stroke or death in patients with severe CRI after carotid endarterectomy. A few studies have shown that carotid angioplasty and stenting was associated with unacceptable risks in patients with CRI and questioned its effectiveness.

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