An Increased Fear in Cardiovascular Patients for Strokes Versus Non-Fatal Myocardial Infarctions and its Implication on Carotid Revascularization Decision-Making

ABSTRACT Endovascular stenting of the carotid artery continues to incite debate among practitioners regarding its superiority over the traditional approach of carotid endarterectomy for reduction of stoke incidence. The 2013 Carotid Revascularization Endarterectomy versus Stenting Trial concluded there was no difference between the two techniques as carotid endarterectomy increased the prevalence of a nonfatal myocardial infarction while a higher incidence of strokes was observed after carotid stenting. The inclusion of myocardial infarction as part of the primary endpoint has drawn criticism; however, in this dispute, a key component is missing: the patient's perspective. A patient's values and fears are crucial to the choice between therapies carrying different risks. We surveyed 500 cardiovascular patients using a qualitative scale (from 1, not at all fearful, to 5, very fearful) to determine their level of fear of stroke, non-fatal myocardial infarction, and limb amputation as well as their understand...