Should Carotid Patients Skip Surgery?
Medication Often Enough to Treat Asymptomatic Carotid Stenosis, Study Shows
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Carotid Artery Stenosis: Study Details continued...
Although 12.6% of the patients treated before 2003 had microemboli, just
3.7% of those treated since 2003 did, Spence found. The difference is
statistically significant, he says.
The research team then followed the patients for at least a year to see what
percentage had strokes or heart attacks. In those treated before 2003, "the
one-year stroke risk was 4%," Spence says. In those treated since 2003, it
"Heart attack risk went from 6.5% to zero percent," he says, with
the group treated since 2003 having no heart attacks.
Asymptomatic Carotid Stenosis: Putting Risk in Perspective
Spence says the risk from surgery or stenting is greater than the risk of
stroke for most patients.
The risk of death or stroke from surgery or stenting is typically considered
about 5% in the 30-day period after the procedure, Spence says.
In his study, 96% of patients without microemboli had only a 1% risk of
stroke in the next year.
So he concludes that patients who don't have microemboli are better off
sticking to medical therapy alone.
In the U.S., according to Spence, ''between half and 2/3 of patients with
asymptomatic carotid artery stenosis have been getting carotid artery surgery
or stenting," he says.
His research, he says, suggests that the idea of performing surgery if there
are not symptoms and no microemboli is outdated. "If someone wants to
perform surgery or stenting on your carotid artery and you have had no symptoms
from it, and they are not talking about microembolic detection, you should run
in the other direction," he says.
Carotid Artery Stenosis: Second Opinion
The study’s findings don't warrant the conclusion, says Lee Schwamm, MD,
vice chairman of neurology at Massachusetts General Hospital, Boston, and a
spokesperson for the American Heart Association.
The study does show that the microemboli have decreased since patients have
been treated with more aggressive medicine regimens, he says.
"The argument here is that the old numbers of the percent [of patients]
who will go on to have a stroke are outdated," he says.