Critical Issues That Need to Be Addressed to Improve Outcomes for Patients With Carotid Stenosis

Angiology. 2016 May;67(5):420-6. doi: 10.1177/0003319716631266. Epub 2016 Feb 27.


Significant improvement in outcomes for patients with carotid stenosis requires liberation from the historic fixation with randomization and a procedurally based, late-stage, reactive approach to medical care. We require a multipronged and multidisciplinary approach that includes all of the following: (i) removal of overreliance on, and biased use of, randomized trial data; (ii) using accurate ways to rank evidence quality and relevance; (iii) improved research reporting standards; (iv) building quality assurance and other research capability into routine practice; (v) producing evidence-true rather than evidence-based guidelines; (vi) bringing current optimal medical treatment to the community and measuring its effectiveness; (vii) funding only interventions known to help patients when and where they are treated and use the savings to fund vital research, including quality assurance in routine practice; and (viii) recognize that making the indication for carotid procedures obsolete is a good thing.

Keywords: carotid angioplasty/stenting; carotid endarterectomy; carotid stenosis; guidelines; quality assurance; stroke prevention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Angioplasty* / methods
  • Carotid Stenosis / diagnosis
  • Carotid Stenosis / therapy*
  • Endarterectomy, Carotid* / methods
  • Humans
  • Stents*
  • Stroke / therapy*
  • Treatment Outcome