In an era where medical management has improved dramatically and new technology in the form of carotid stents is available for poor operative candidates, it is reasonable to continually reevaluate the role of traditional open revascularization for both symptomatic and asymptomatic carotid disease. Indeed, the existence of CREST-2 (Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial) and other ongoing clinical trials substantiates this need. Nevertheless, selection criteria and cost limitations generally necessitate that traditionally designed trials have a less generalizable population and may not be suitable or powered for subgroup analysis. To this end, observational studies, such as the one performed by Cooper et al1 in this issue of JAMA Surgery, provide valuable insight into both specific patient populations and real-word effectiveness.
Johnston LE, Upchurch GR. High-Risk Patients in the Evolving Landscape of Carotid Revascularization. JAMA Surg. 2016;151(10):952-953. doi:10.1001/jamasurg.2016.1505