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Deshmukh D. N., Illig K. A.
Division of Vascular Surgery University of Rochester Medical Center Rochester, NY, USA
It is a fallacy to state that an endovascular approach is always less invasive than surgery and that outcomes are independent of patient risk: the morbidity and mortality of carotid artery stenting (CAS) is not independent of patient risk. Risk is a slippery subject – difficult to categorize, and even harder to quantify. We wish to stress that not only is the outcome of CAS dependent on patient risk, but also that each patient risk factor should be considered independently and affects the outcomes of carotid endarterectomy (CEA) and CAS to different degrees. There is no such thing as a “low-risk” or “high-risk” patient – rather each patient has some number of discrete factors, which influence the risk of either procedure in different ways. When deciding between CEA and CAS the practitioner should consider each patient on a case-by-case basis with particular attention paid to specific risk factors before deciding on one therapy over the other.