Carotid surgery on asymptomatic patients: Why not?

Introduction: Carotid surgery on asymptomatic patients is stilt controversial. Its cost-effectiveness has been questioned due to the number of patients needed to treat to prevent a stroke, especially when compared with surgery on symptomatic patients. Objectives: To analyse a series of patients, in a single centre, subjected to surgery due to asymptomatic carotid stenosis (ACS), as well as to determine the theoretically prevented strokes and to extrapolate to different intervals and morbimortality rates. Material and methods: Design. Historic cohort. Population. Successive patients subjected to endarterectomy for ACS>70% in the last 5 years. Method. A review was made of the medical records of all the patients subjected to surgery due to ACS in the period 2009-2013. Statistical analysis. Descriptive, analysis of survival, estimate of prevented strokes based on theoretical number of patients needed to treat. Results: A total of 111 procedures were identified in 97 patients with a mean age of 67.4 +/- 3.4 years. The classic risk factors were: smoking (70.4%), hypertension (80.9%), diabetes (42.6%), and dyslipidaemia (62.6%). Mortality (30-day): on case (0.9%). Neurological morbidity (30-day): no cases (0%). During follow-up (2.7 years, losses: 6.3%), 6 (5.4%) deaths were recorded, as well as one (0.9%) ipsilateral stroke and 4 (3.6%) re-stenosis. The number of theoretically prevented strokes was estimated at 7.3 at 5 years. Conclusion: Based on the results of this series and the estimation of strokes prevented, using different morbidity, mortality and follow-up intervals, it appears that endarterectomy should not be ruled out as a treatment of choice in patients with ACS, provided that there is a reasonable surgical risk and life expectancy. (C) 2014 SEACV. Published by Elsevier Espana, S.L.U. All rights reserved.