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Should Carotid Patients Skip Surgery?

Medication Often Enough to Treat Asymptomatic Carotid Stenosis, Study Shows

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His research, he says, suggests that the idea of performing surgery if there are not symptoms and no microemboli is outdated.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"The argument here is that the old numbers of the percent [of patients] who will go on to have a stroke are outdated," he says.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

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.

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