Surgery unnecessary for 95 percent of those with asymptomatic carotid stenosis

Sep 25, 2008

Research led by Dr. David Spence of Robarts Research Institute at The University of Western Ontario shows that with more intensive medical therapy, the risk of stroke has become so low that at least 95 per cent of patients with asymptomatic carotid stenosis (ACS) would be better off with medical therapy than with surgery or stenting. ACS is a narrowing in the carotid artery, which supplies blood to the brain, which has not yet resulted in a stroke or transient ischemic attack (TIA). In the United States, one-half to two-thirds of the patients being subjected to surgery for revascularization are asymptomatic.

Spence will present his findings September 25th at the 6th World Stroke Congress being held in Vienna, Austria. He is the Director of the Stroke Prevention & Atherosclerosis Research Centre, a professor of neurology and clinical pharmacology at Western's Schulich School of Medicine & Dentistry and the author of "How to Prevent Your Stroke".

Spence says the less than five per cent of ACS patients who could benefit from revascularization can be identified with a procedure called Transcranial Doppler Embolus Detection: a helmet is placed on the head to hold ultrasound probes in place, and the arteries inside the head are monitored for microemboli, small blood clots or chunks of plaque that break off from the narrowing in the carotid artery and go into the brain arteries.

The historical benefit of revascularization for ACS was based on less intensive medical therapy than is now prevalent. Spence and a team of researchers studied 471 ACS patients. Of those, 199 were seen before 2003 and 272 after January 1, 2003. Microemboli were present in 12.6 per cent of patients before 2003, but in only 3.7 per cent since 2003. The decline in microemboli was associated with better control of plasma lipids and slower progression of carotid plaque. Since 2003, there have been significantly fewer strokes and hear attacks.

"The 96 per cent of patients without microemboli have only a one per cent risk of stroke in the next year, whereas the ones with microemboli have a 14 per cent risk of stroke," says Spence. "Since the risk of surgery is four to five per cent, patients without microemboli are better off with medical therapy including medications and lifestyle modifications. Only the ones with microemboli would benefit from carotid endarterectomy or stenting."

Source: University of Western Ontario

Explore further: Experts call for higher exam pass marks to close performance gap between international and UK medical graduates

add to favorites email to friend print save as pdf

Related Stories

More, bigger wildfires burning western US, study shows

26 minutes ago

Wildfires across the western United States have been getting bigger and more frequent over the last 30 years – a trend that could continue as climate change causes temperatures to rise and drought to become ...

Thinnest feasible nano-membrane produced

1 hour ago

A new nano-membrane made out of the 'super material' graphene is extremely light and breathable. Not only can this open the door to a new generation of functional waterproof clothing, but also to ultra-rapid filtration. The ...

Clean air: Fewer sources for self-cleaning

1 hour ago

Up to now, HONO, also known as nitrous acid, was considered one of the most important sources of hydroxyl radicals (OH), which are regarded as the detergent of the atmosphere, allowing the air to clean itself. ...

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0

More news stories

Filipino tests negative for Middle East virus

A Filipino nurse who tested positive for the Middle East virus has been found free of infection in a subsequent examination after he returned home, Philippine health officials said Saturday.

Study says we're over the hill at 24

(Medical Xpress)—It's a hard pill to swallow, but if you're over 24 years of age you've already reached your peak in terms of your cognitive motor performance, according to a new Simon Fraser University study.

NASA's space station Robonaut finally getting legs

Robonaut, the first out-of-this-world humanoid, is finally getting its space legs. For three years, Robonaut has had to manage from the waist up. This new pair of legs means the experimental robot—now stuck ...

Ex-Apple chief plans mobile phone for India

Former Apple chief executive John Sculley, whose marketing skills helped bring the personal computer to desktops worldwide, says he plans to launch a mobile phone in India to exploit its still largely untapped ...

Egypt archaeologists find ancient writer's tomb

Egypt's minister of antiquities says a team of Spanish archaeologists has discovered two tombs in the southern part of the country, one of them belonging to a writer and containing a trove of artifacts including reed pens ...

Airbnb rental site raises $450 mn

Online lodging listings website Airbnb inked a $450 million funding deal with investors led by TPG, a source close to the matter said Friday.