From the Research
The best approach to manage patients who continue to smoke after carotid endarterectomy is a comprehensive smoking cessation program that combines pharmacotherapy with behavioral support, as evidenced by the most recent study in 2024 1.
Key Components of the Program
- Pharmacotherapy: first-line medications such as varenicline, bupropion SR, or nicotine replacement therapy
- Behavioral support: regular counseling sessions, either individually or in group settings, scheduled every 1-2 weeks initially, then monthly for at least 3-6 months
Rationale
Continued smoking after carotid endarterectomy significantly increases the risk of restenosis, stroke, myocardial infarction, and death, as nicotine and other tobacco toxins promote inflammation, platelet aggregation, and endothelial dysfunction that can compromise surgical outcomes. The combination of medication and behavioral support has been shown to be more effective than either approach alone, with quit rates potentially increasing two to three-fold compared to unassisted attempts.
Supporting Evidence
- A 2024 study published in the Journal of Vascular Surgery found that preoperative smoking cessation in patients with asymptomatic carotid stenosis significantly reduces the risk of stroke, mortality, and major adverse cardiac events following carotid endarterectomy 1.
- A 2020 study published in the Journal of Vascular Surgery found that active smokers are at increased risk for death after carotid endarterectomy compared with matched counterparts, highlighting the importance of smoking cessation before undergoing carotid endarterectomy 2.
- A 2022 study published in the Journal of Vascular Surgery found that a regional smoking cessation intervention for vascular surgery patients, which included brief physician-delivered advice, referral to telephone-based counseling, and nicotine replacement therapy, was associated with encouraging quit rates and identified an opportunity for longer-term intervention to maintain even greater 1-year tobacco cessation 3.