Outcomes are improving for patients with carotid stenosis

The fact that stroke prevention has become so much more effective over the last several decades calls for celebration. Improvements in understanding the benefits of encouraging a healthy lifestyle, more effective use of medications, and improved technique of preventive procedures account for the change. The systematic review by Munster et al.(1) documents a 70% decline in the 30-day incidence of stroke or death associated with carotid endarterectomy (CEA) for 50%-99% asymptomatic carotid stenosis, from approximately 4% in the early 1990s to 1.2% in 2013. The rate of perioperative death alone fell 75% from approximately 1.3% to 0.4%. Measurements from 204,622 patients from 47 registries demonstrate these dramatic declines in the rates of devastating complications. Operative safety in research trials (mostly randomized trials) has shown similar magnitude improvements, but this failed to reach statistical significance due to smaller patient numbers (6 trials involving 4,431 procedures)