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Comment & Response
April 2014

Uncertainty in Management of Carotid Stenosis in Women—Reply

Author Affiliations
  • 1Division of Vascular Surgery, Medical College of Wisconsin, Milwaukee
  • 2Divison of General Surgery, Medical College of Wisconsin, Milwaukee
  • 3Center for Translational Injury Research, Department of Surgery, University of Texas, Houston
JAMA Surg. 2014;149(4):402-403. doi:10.1001/jamasurg.2013.4867

In Reply Multiple retrospective series have identified female sex as a risk factor for perioperative stroke and death after carotid endarterectomy (CEA).1 An international consensus,2 as discussed by De Rango and colleagues, states that “according to the currently available literature, cardiovascular screening, risk factor control, and optimization of medical therapy should be intensified for all women with symptomatic or asymptomatic carotid stenosis.” However, international differences in practice must be reviewed. Dr Cambria’s recent article states that “the data indicate that for symptomatic patients, CEA is the preferred treatment strategy in virtually all patient populations…in addition, best medical therapy would only be a logical treatment alternative in patients with comorbid conditions expected to limit their longevity to less than a year. The SVS [Society for Vascular Surgery] knows of no data that would indicate that specific sex, or racial/ethnic background would have a material impact on the above conclusions.”3(p6) This statement is a testament to the differences in the management of carotid stenosis around the world.

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