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    Carotid Artery Surgery May Prevent Stroke

    Surgery vs. Watchful Waiting continued...

    "The reduction of about four-fifths in carotid [artery-related] stroke is so extreme that it can be reasonably" advised for patients who have severe carotid artery blockages, writes Halliday.

    Although wider use of cholesterol-lowering statin drugs will somewhat reduce the overall risk of stroke, the remaining risk "should be avoidable by successful surgery," she writes. Unsuccessful surgery, however, can do much harm if it's done by an inexperienced or unskilled surgeon.

    Good use of drug therapy should lower any remaining risks -- both after surgery and if surgery is not performed, she writes.

    Carotid surgery is best for patients under age 74, writes Halliday. Half of all older patients die within five years from unrelated causes. She will continue following patients in her study for a full 10 years.

    Get a Good Surgeon

    In a commentary in The Lancet, one surgeon points out that choosing your surgeon carefully is essential.

    "Patients must recognize that with good medical care, they face only a 2% annual stroke rate, which falls below 1% after a successful carotid artery [surgery]," writes H.J M. Barnett, MD, of Ontario, Canada. But if the surgery is performed under less than optimal conditions, the benefits "could be obliterated."

    He advises checking the surgeon's track record, which should be readily available from the referring physician. Any hospital should require an independent audit of surgical death rates and ensure their ready availability, Barnett writes. Having a less-than-skilled surgeon "quickly casts [carotid surgery] into the list of 'risk factors for stroke,'" he concludes.

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