"We now know definitively that we can reduce stroke risk by half with surgery to 'clean out' narrowed arteries leading to the brain even in patients who have no symptoms," says neurologist James Toole, M.D. "We should offer this option to more patients, as well as begin screening seemingly healthy individuals for stroke risk."
Toole's comments are in response to a report in this week's The Lancet on the "Asymptomatic Carotid Surgery Trial," a study based in England of more than 3,000 patients. The results that surgery to remove fatty deposits from narrowed vessels in the neck can significantly reduce stroke risk were nearly identical to the findings of a study that Toole coordinated in the United States and Canada.
Both studies looked at the value of surgery, called carotid endarterectomy, in people who have no symptoms, but whose carotid arteries were narrowed by at least 60 percent, a condition called carotid artery stenosis. The surgery is typically offered only to patients who have symptoms of an impending stroke.
The idea that surgery can be beneficial for people without symptoms was not easy for physicians and researchers to believe when it was first reported in 1995, says Toole, a professor of neurology. "People were so astonished by this they thought the data were flawed. That led to the European study."
The recent study, called the Asymptomatic Carotid Surgery Trial and reported in The Lancet, involved 126 hospitals in 30 countries. The study randomized people with narrowed vessels to receive either surgery or daily aspirin and management of risk factors, such as drugs to lower cholesterol or hi
Contact: Karen Richardson
Wake Forest University Baptist Medical Center