Should Carotid Patients Skip Surgery?
Medication Often Enough to Treat Asymptomatic Carotid Stenosis, Study Shows
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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are not symptoms and no microemboli is outdated.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who will go on to have a stroke are outdated," he says.
But the study, he says, is observational. "The benefit of [ultrasound]
monitoring has not been demonstrated in a large population," Schwamm tells
A patient with many microemboli is probably at high risk of a stroke, he
agrees. "But if you don't [have high levels of microemboli], it doesn't
mean you are safe," he says.
"The data presented does not support the conclusion that only patients
with microemboli should be considered for 'revascularization' -- surgery or
stenting," he says.
That conclusion, he says, is premature, at least until more studies produce
the same results.