Why are asymptomatic patients with CAD being defined as “high risk”?
There is no good answer. Beauty is in the eye of the beholder. Risk is in the opinion of the person evaluating risk. The only kind of good-risk patients are young soldiers. All our patients with arteriosclerosis are certainly not kids; they’re at least 45 or 50 or usually older. They all have generalized hardening of the arteries, including their coronary arteries, and then you superimpose other risks in the elderly on that. How should asymptomatic patients be treated? There are many patients with asymptomatic CAD in whom the carotid lesion is picked up on a Duplex, or there’s a bruit in the neck. Many of those patients are bad risks, because they’ve had heart attacks or whatever. In my opinion, if they’re high risk and asymptomatic from the carotid stenosis, they shouldn’t be referred for treatment. There is level 1 evidence that shows that if you take a population of patients with asymptomatic stenosis, and you treat one group medically and the other group with carotid surgery, the g
