156 Carotid endarterectomy in the era of optimum medical therapy – is it becoming a relic?

Abstract Introduction Medical therapy for carotid disease has been advancing over the last 20 years and there is speculation that it could substantially reduce presentation with symptomatic carotid stenosis. This study was conducted to determine prevalence of best medical therapy in patients with symptomatic disease at the point of index presentation, prior to carotid endarterectomy (CEA). Methods Retrospective analysis of urgent CEA patients at a vascular hub in North West London between 2021 and 2023 was conducted. Data regarding their index presentation with presenting features of symptomatic stenosis was collected. Co-morbidities and drug history was recorded at admission and discharge (including antiplatelets, anticoagulants, antihypertensives and diabetic control). Distribution of drugs prescribed pre- and post-CEA was compared using the Chi2 test, while binary logistic regression was utilised to determine the likelihood of being on medication pre-CEA. Results 124 patients were consecutively analysed. Hypertension and hyperlipidaemia were the most common pre-CEA morbidity recorded (64% and 42% respectively). 92 patients (74%) were on an antiplatelet, statin or antihypertensive. Thirty-six patients (29%) were on a combination of an antiplatelet, antihypertensive and statin during their index presentation. There was no significant difference between patients on best medical therapy pre- and post-CEA. Conclusion Patients undergoing CEA are multi-morbid and are more likely to be on cardiovascular risk modifying therapy at their index presentation of symptomatic carotid artery stenosis, indicating that endarterectomy remains a useful and relevant intervention in the era of improving medical therapy.