Comparative Effectiveness of Carotid Endarterectomy vs Initial Medical Therapy in Patients with Asymptomatic Carotid Stenosis

Abstract

Importance: Carotid endarterectomy (CEA) among asymptomatic patients involves a trade-off between a higher short-Term perioperative risk in exchange for a lower long-Term risk of stroke. The clinical benefit observed in randomized clinical trials (RCTs) may not extend to real-world practice. Objective: To examine whether early intervention (CEA) was superior to initial medical therapy in real-world practice in preventing fatal and nonfatal strokes among patients with asymptomatic carotid stenosis. Design, Setting, and Participants: This comparative effectiveness study was conducted from August 28, 2018, to March 2, 2020, using the Corporate Data Warehouse, Suicide Data Repository, and other ..