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 was 0.8%.
"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His research, he says, suggests that the idea of performing surgery if there are not symptoms and no microemboli is outdated.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"The argument here is that the old numbers of the percent [of patients] who will go on to have a stroke are outdated," he says.