Source: EJVES Sep 2016
According to the trials, NO …. but what would you do when the plaque is ‘vulnerable’? Well … this study from Sweden for three years showed that the recurrent rate for stroke is about 7% in 3 yrs in Symptomatic mild stenosis. This is too high.
The commentary on the article put very nice rules:
A combinations of mild (20–49%) and moderate (50–69%) percent stenosis with stable or unstable plaque morphology is given in the following 2 × 2 matrix.
The four combinations for recurrent stroke risk are:
- (a) low % stenosis and stable plaque,
- (b) low % stenosis and unstable plaque,
- (c) moderate % stenosis and stable plaque, and
- (d) moderate stenosis and unstable plaque.
One might predict that
- (a) be strongly considered for current best medical therapy and that
- (d) be recommended for CEA.
- The optimal management outcomes for (b) and (c) are unknown and clearly deserve a trial.
- If I had a TIA or minor stroke and (b), mild stenosis and an unstable plaque, I would strongly consider CEA.
- In contrast, if I had (c), moderate stenosis, and stable plaque, I might choose current best medical management, unless I was already on it.
This is really interesting argument …
