Introduction:

Treatment decision in patients with asymptomatic carotid artery stenosis (ACS) is a matter of current debate with a recent shift towards isolated best medical treatment (BMT) as treatment of choice in most patients. However, poor medical compliance is one of the main constraints to the success of BMT. We hypothesized that more invasive treatment approaches can influence how patients perceive the severity of their illness and hence, treatment compliance.

Methods:

A cross-sectional study was performed including patients with asymptomatic >50% carotid artery stenosis (NASCET method) followed-up as outpatients in a Vascular Surgery department from January 2017 to December 2021.

Optimal BMT was defined according to the European Society of Vascular Surgery Carotid Atherosclerotic Disease 2023 guidelines.

Demographic and risk factor patient data was attained and subsequently a Portuguese translation of the Morisky medication-taking adherence scale (MMAS-4) questionnaire was given to all patients. Several additional questions developed by our group were also applied.

Results:

A total of 320 patients were identified (186 under BMT alone and 134 submitted to BMT and carotid endarterectomy - CEA). Most patients were male in both groups (75%) and the mean age was similar. Furthermore, patients undergoing CEA presented higher rates of current smoking (51.4% vs 15.9%; p<0.001) and lower rates of antiplatelet (80.0% vs. 92.8%; p=0.029) and statin (78.6% vs. 94.2%; p=0.007) prescription.

Patients in the CEA group also presented with significantly lower medical compliance (40.3% vs. 24.5%, p<0.001) despite being more aware of their current medication´s name and therapeutic purpose.

Conclusion:

In conclusion, physicians seem to be more aggressive in controlling risk factors in BMT-only patients when compared to CEA-submitted patients. However, patients subjected to CEA may be more aware of ACS, despite having poorer medical adherence.

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