Personalized medicine: new enhancement to guidelines on carotid endarterectomy and stenting

Current guidelines are founded on evidence-based medicine (EBM), a method that privileges results from randomized control trials (RCTs). However, RCTs are frequently conducted on cohorts selected on the basis of rigid inclusion criteria, often excluding patients with multimorbidities, a condition that is becoming increasingly prevalent in the real world. The resulting recommendations may, therefore, be targeted to the “representative” patient, as resulting from the statistical mean of the RCTs, and risk being applied rigidly to patients that more often than not present with a more complex clinical picture than that modeled in the pivotal trials. The new paradigm to overcome this limitation is Personalized Medicine, which aims to take into account the particular characteristics displayed by the individual. Guidelines on carotid endarterectomy and stenting must thus be integrated with “tailored” or “personalized” recommendations. The authors thus reviewed the literature available on carotid endarterectomy and stenting for stroke prevention, taking into account risk/benefit models and evidence on subgroups. This guideline offers new recommendations on Personalized Medicine for carotid endarterectomy and stenting that can be followed in addition to classical recommendations.