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Surgery Is Not the Answer for Preventing All Strokes

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WebMD Health News

March 14, 2000 (Washington) --In an effort to prevent strokes, surgeons sometimes literally scrape the gunk out of clogged blood vessels that run along the neck and up to the brain, called carotid arteries. While this may be effective, a new study shows that second strokes can occur anyway, brought on by causes unrelated to the carotid arteries -- sometimes even caused by this surgery itself.

The author of the study, published in the March 15 Journal of the American Medical Association, says he hopes it prompts physicians to consider a variety of stroke causes before rushing a patient to surgery. Henry J. M. Barnett, MD, tells WebMD that he is particularly concerned about ultrasound tests being advertised by firms promising to reduce a person's risk of stroke "in just 10 minutes" for $35. One such flyer promoted a test available at a Methodist Church in a city in central Florida, home to a large elderly population.

"There are probably 2 million people right today who have some [blockage] of their carotid arteries," says Barnett, a professor emeritus at the department of clinical neurological sciences at the University of Western Ontario in London, Ontario. "If they got surgery based on some tests in the church basement, they would flood the system and more of them would be harmed than helped." Barnett was the lead researcher of the study, which compared the long-term survival of people with carotid artery disease who underwent the surgical cleaning with those who did not.

Every year, some 50,000 Americans will have a "mini-stroke," in which a small blood clot lodges in an artery and, usually, dissolves on its own. To prevent a full stroke, the vessel-cleaning procedure, called an endarterectomy, is sometimes performed to clear the carotid arteries of blockages.

The surgery, Barnett says, is not without risks. "Six percent of patients will leave the operating room with a stroke, and 2% will be debilitating. And only the best surgeons can do it," he says.

His study looked at nearly 3,000 patients, of whom nearly 800 had had strokes, some more than one.

Among the strokes counted in the study, a third had causes other than blockages in the carotid arteries. Smaller blood vessels were the cause in 20%, while 10% came from blood clots that originated in the heart and then became lodged in the brain. Among the patients who previously had surgery, the researchers found that up to 45% of their strokes did not occur in areas where the vessels had been clogged. Among the strokes related to the heart, many were caused by an irregular heart rhythm, called atrial fibrillation, which is easily treatable with medication.

"We hope that people will pay attention to their patients and make sure they are not the sort of patient who needs treatment of the heart and things that will cause small vessel disease -- hypertension, diabetes, and high cholesterol," Barnett says. "If they have never had any symptoms at all, by all means just don't think about the arteries in the neck."

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