ABSTRACT
There is good evidence that operative risk for patients with symptomatic stenosis differs depending on the type of symptomatic event (19,21). A systematic review of all surgical case series published from 1980 to 2001 inclusive that reported the risk of stroke and death due to CEA identified 103 studies that stratified risk by indication (19). Operative risk was the same for CEA for stroke and cerebral TIA (OR¼ 1.16, 0.99-1.35, P¼ 0.08, 23 studies), but was higher for cerebral TIA than for ocular events only (OR¼ 2.31, 1.72-3.12, P < 0.00001, 19 studies), and the risk of CEA for re-stenosis was higher than for primary surgery (OR¼ 1.95, 1.21-3.16, P¼ 0.018, six studies). Interestingly, the operative risk in patients with only ocular events only tended to be even lower than for asymptomatic stenosis (OR¼ 0.75, 0.50-1.14, 15 studies). Thus, the risk of stroke and death due to CEA is highly dependent on the clinical indication. Audits of risk should be stratified accordingly, and patients should be informed of the risk that relates to their presenting event.
