Lower ischemic complications

With the increasing use of stent-assisted angioplasty for the treatment of extracranial carotid occlusive disease, it is becoming more widely acknowledged that such endovascular reconstructive techniques can be performed with a relatively low rate of peri-operative cerebral ischemic complications [42, 49-52]. These ischemic complications, on average appear to be lower than those for therapeutic occlusion of the carotid artery using either open or endovascular techniques. 

As yet there are no completed megatrials with the newer statins. A study that compared atorvastatin versus angioplasty in 341 patients with stable CHD over 18 months was recently reported (Pitt et al., 1999). There were fewer ischemic events in the atorvastatin group, but the difference did not quite reach statistical significance. Furthermore, a previous study had shown a significantly lower incidence of such events in a group treated with conventional medical therapy, because angioplasty can be complicated by myocardial infarction and other acute coronary events (RITA-2 trial participants, 1997). 

However, without formal risk models, clinicians are often inaccurate in assessment of risk in their patients (Grover et al. 1995). Moreover, the absolute risk of a poor outcome for patients with multiple specific characteristics cannot simply be derived arithmetically from data on the effect of each individual characteristic such as age or severity of illness that is, one cannot simply multiply risk ratios for these characteristics together as if they were independent. Even if one could, it would still be rather complicated. In a patient with symptomatic carotid stenosis, for example, what would the risk of stroke without endarterectomy be in a 78-year-old (high risk) female (lower risk) with 80% stenosis who presented within two days (high risk) of an ocular ischemic event (low risk) and was found to have an ulcerated carotid plaque (high risk) ... 

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