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Carotid stenosis management: time to address the misconceptions (‘furphies’)

Improper management of carotid artery disease for stroke prevention is prevalent. Accumulating misconceptions (‘furphies’) drive the overuse of carotid artery procedures and the inappropriate use of medicines. Recognition of these furphies is essential to improve disease management and optimize patient outcomes.

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References

  1. Abbott, A. L. et al. Misconceptions regarding the adequacy of best medical intervention alone for asymptomatic carotid stenosis. J. Vasc. Surg. 71, 257–269 (2020).

    Article  Google Scholar 

  2. Naylor, A. R. et al. Editor’s choice — management of atherosclerotic carotid and vertebral artery disease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur. J. Vasc. Endovasc. Surg. 55, 3–81 (2018).

    Article  CAS  Google Scholar 

  3. Abbott, A. L. et al. Systematic review of guidelines for the management of asymptomatic and symptomatic carotid stenosis. Stroke 46, 3288–3301 (2015).

    Article  Google Scholar 

  4. Batchelder, A. J. et al. Overview of primary and secondary analyses from 20 randomised controlled trials comparing carotid artery stenting with carotid endarterectomy. Eur. J. Vasc. Endovasc. Surg. 58, 479–493 (2019).

    Article  Google Scholar 

  5. Brott, T. G. et al. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N. Engl. J. Med. 363, 11–23 (2010).

    Article  CAS  Google Scholar 

  6. Halliday, A. et al. 10-year stroke prevention after successful carotid endarterectomy for asymptomatic stenosis (ACST-1): a multicentre randomised trial. Lancet 376, 1074–1084 (2010).

    Article  Google Scholar 

  7. Bonati, L. H. et al. Long-term outcomes after stenting versus endarterectomy for treatment of symptomatic carotid stenosis: the International Carotid Stenting Study (ICSS) randomised trial. Lancet 385, 529–538 (2015).

    Article  Google Scholar 

  8. McNeil, J. J. et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N. Engl. J. Med. 379, 1509–1518 (2018).

    Article  CAS  Google Scholar 

  9. Anand, S. S. et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 391, 219–229 (2018).

    Article  CAS  Google Scholar 

  10. Ganesan, A. N. et al. The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis. Eur. Heart J. 37, 1591–1602 (2016).

    Article  Google Scholar 

Download references

Acknowledgements

A.L.A. is a neurologist who has received grants for independent research into stroke prevention from the National Health and Medical Research Council of Australia and the BUPA Health Foundation. A.L.A. is the founding member of the Faculty Advocating Collaborative and Thoughtful Carotid Artery Treatments (FACTCATS; see FACTCATS.org).

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Correspondence to Anne L. Abbott.

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Abbott, A.L. Carotid stenosis management: time to address the misconceptions (‘furphies’). Nat Rev Cardiol 18, 383–384 (2021). https://doi.org/10.1038/s41569-021-00543-2

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