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Invited Commentary
March 2018

Outcomes in Asymptomatic Redo Carotid Endartectomy: A Word of Caution

Author Affiliations
  • 1University of Virginia Medical Center, Division of Vascular Surgery, Department of Surgery, Charlottesville
JAMA Surg. 2018;153(3):259-260. doi:10.1001/jamasurg.2017.4492

Arhuidese et al1 compare primary carotid endartectomy (CEA) and redo CEA using the Society for Vascular Surgery Vascular Quality Initiative database.1 This large study compares 64 118 primary CEAs with 1369 redo CEAs, with the primary outcomes of stroke, death, myocardial infarction, stroke/death, and stroke/death/myocardial infarction at 30 days and at 1-year follow-up. The higher incidence of stroke, death, stroke/death, and stroke/death/ myocardial infarction in the asymptomatic redo CEA group compared with the primary CEA group but not in the symptomatic patients is the primary finding in this study. This finding is contrary to most studies in the literature that suggest symptomatic carotid interventions almost always carry a higher stroke rate than interventions on asymptomatic patients. (Table 2)