Editorial |

Carotid Stenting at the Crossroads:  Practice Makes Perfect, But Some May Be Practicing Too Much (and Not Enough)

Ethan A. Halm, MD, MPH
JAMA. 2011;306(12):1378-1380. doi:10.1001/jama.2011.1384.
Text Size: A A A
Published online


Stroke is a major cause of death and disability. Approximately 10% to 15% of ischemic strokes are attributable to atherosclerosis of the internal carotid arteries,1 and there is great interest in surgical and endovascular approaches to stroke prevention. Carotid artery surgery or endarterectomy (CEA) has been the traditional intervention, and carotid angioplasty with stenting (CAS) is the newer percutaneous procedure. Both procedures increase the short-term risk of death or stroke due to the intervention in exchange for a lower long-term risk of stroke.2,3 Therefore, the magnitude and balance of the risks and benefits for these procedures are crucial considerations. Patients with symptomatic disease (ie, those who have had a stroke or transient ischemic attack in the past 6-12 months in the distribution of a carotid artery with ≥50% stenosis) benefit from CEA, which reduces the absolute risk of stroke by 8% per year.4 Asymptomatic patients (those with carotid occlusive disease without neurological symptoms) have a more modest benefit from CEA (absolute stroke reduction of 0.8%-1% per year).5,6 Carotid artery surgery or endarterectomy is considered beneficial only if it can be performed with a 30-day risk of death or stroke of 6% or less among symptomatic patients and 3% or less among those who are asymptomatic.2,3

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
First page PDF preview




Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 3

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Topics
PubMed Articles