Overtreatment or Undertreatment of Carotid Disease: A Transatlantic Comparison of Carotid Endarterectomy Patient Cohorts
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Outcomes after carotid revascularization and medical therapy in randomized controlled trial (RCTs) have improved over time1; however, their generalizability to general practice has been questioned, fueling the debate on the treatment of carotid stenosis. This is most apparent in global differences in the selection of asymptomatic patients for carotid endarterectomy (CEA). For instance, asymptomatic patients comprise a mere 2.8% of all patients undergoing revascularization in the Netherlands2, compared with 66% in the United States.3
However, it is unknown how the difference in the proportion of asymptomatic CEA patients between the United States and the Netherlands impacts the type of patients selected for revascularization or their outcomes. Thus, we compared patient characteristics and outcomes for patients undergoing CEA in the United States and in the Netherlands.
We used the Targeted Vascular module of the National Surgical Quality Improvement Program (NSQIP) registry and the Dutch Athero-Express registry. NSQIP collected data from 89 centers, accounting for 5% of all CEAs performed in the United States annually.4 The Athero-Express registry collected data from 2 Dutch centers, which …