Comment on: Identification of patient characteristics that may improve procedure selection for the treatment of carotid stenosis

Correspondence to: Haogeng Sun (email: s666888sci@163.com)

37 Guoxuexiang Street, Chengdu

Tel: 028-85423489

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BJS, https://doi.org/10.1093/bjs/znae227, published 03 October 2024

We have read the recent publication by Andreas Kuehnl et al. in BJS1. The study provides valuable insights into factors that may influence the outcomes of carotid endarterectomy (CEA) and carotid artery stenting (CAS), offering significant evidence for optimizing treatment selection for patients with carotid stenosis.

We commend the authors for their comprehensive analysis of the largest patient sample to date, which notably includes variables such as age, treatment side, ASA grade, degree of contralateral stenosis, and their interactive effects. These factors contribute a more nuanced understanding of which surgical intervention to choose for patients with carotid stenosis.

However, as the authors mention in the supplementary material, there is a concern regarding the non-random assignment of patients to CEA and CAS treatment groups. Is there a potential bias in the selection of surgical procedures? Additionally, it is regrettable that information on patient medication use, particularly antiplatelet and statin therapies2,3, which can influence the occurrence and prognosis of outcome events, was not available. Furthermore, due to regional variations in medical practice, healthcare accessibility, and population characteristics, these findings may not be representative of a broader global population. Future studies should consider including a more diverse population from multiple regions to enhance the generalizability of the results. It is hoped that ongoing research will address these limitations through prospective studies or RCTs.

In conclusion, the study by Kuehnl et al. makes an important contribution to treatment selection for patients with carotid stenosis by identifying key patient characteristics that can guide clinical decision-making. We look forward to seeing how these findings will impact on future guidelines and whether they can improve patient outcomes.