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To the Editor:
Evans and Wijdicks1 recently reported that internal carotid artery (ICA) stenosis carried a perioperative stroke risk of approximately 3.6% in a series of 284 unselected patients undergoing general anesthesia and noncardiac, noncarotid surgery. For prophylactic carotid endarterectomy to be recommendable in patients with known ICA stenosis, they suggested that the global perioperative risk of carotid endarterectomy plus the general surgical procedure would need to be significantly lower than 3.6%. Although this risk was higher than in unselected population, they concluded that it was not sufficient to prompt prophylactic carotid endarterectomy. This conclusion is correctly based on the crude sum of the percentages emerging from the study, but could be misleading.
First, caution is needed in drawing conclusions for clinical management from small series, such as the one reported by Evans and Wijdicks,1 which included 10 cases observed over 10 years. Small numbers prevented any stratification of the risk …
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