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Timely surgery dramatically reduces stroke risk for people with carotid stenosis (p 915)
March 17, 2004Surgical intervention to remove narrowing in the carotid artery (carotid endarterectomy) could substantially reduce the risk of major strokes in certain groups of patients if it is done sufficiently soon after a "warning stroke" or transient ischaemic attack (TIA), suggest authors of a UK study in this week's issue of THE LANCET.
Peter Rothwell from the University of Oxford, UK, and colleagues analysed pooled data from two trials (the European Carotid Surgery Trial and North American Symptomatic Carotid Endarterectomy Trial) to assess the risk of stroke without surgery, the risk of stroke and death due to surgery, and the overall benefit from surgery.
Data for around 5900 people were available from the two trials. Benefit from surgery was greatest in men, patients aged 75 years or older, and those randomised within 2 weeks after their warning stroke, and fell rapidly with increasing delay.
Dr Rothwell comments: "Benefit is particularly dependent on the delay to surgery after the presenting event. Ideally, the procedure should be done within 2 weeks. Unfortunately, in the UK and elsewhere, the operation is often not done until several months after the event - even if the patient seeks medical attention immediately after their warning stroke. Benefit from surgery is very much reduced at this time, and many patients who would have benefited have their major stroke whilst waiting for surgery."
The need for urgent investigation and treatment stems from the high risk of major stroke in the first few days and weeks after a TIA or warning stroke. Dr Rothwell adds: "There is therefore a need to educate the public about the symptoms of warning strokes and TIAs so that people seek medical attention immediately. The importance of this latest study is that it shows that many more strokes can be prevented if treatment is initiated early. The problem currently in the UK, and in many other countries, is that we are just not set up to investigate and treat patients sufficiently quickly". (Quote by e-mail; does not appear in published paper).
Lancet
Dr Rothwell comments: "Benefit is particularly dependent on the delay to surgery after the presenting event. Ideally, the procedure should be done within 2 weeks. Unfortunately, in the UK and elsewhere, the operation is often not done until several months after the event - even if the patient seeks medical attention immediately after their warning stroke. Benefit from surgery is very much reduced at this time, and many patients who would have benefited have their major stroke whilst waiting for surgery."
The need for urgent investigation and treatment stems from the high risk of major stroke in the first few days and weeks after a TIA or warning stroke. Dr Rothwell adds: "There is therefore a need to educate the public about the symptoms of warning strokes and TIAs so that people seek medical attention immediately. The importance of this latest study is that it shows that many more strokes can be prevented if treatment is initiated early. The problem currently in the UK, and in many other countries, is that we are just not set up to investigate and treat patients sufficiently quickly". (Quote by e-mail; does not appear in published paper).
Lancet
Stroke Current Events and Stroke News RSSSurgery not linked to memory problems in older patients
For years, it has been widely assumed that older adults may experience memory loss and other cognitive problems following surgery. But a new study from researchers at Washington University School of Medicine in St. Louis questions those assumptions.
Pushing the brain to find new pathways
Until recently, scientists believed that, following a stroke, a patient had about six months to regain any lost function. After that, patients would be forced to compensate for the lost function by focusing on their remaining abilities.
Night Beat, Overtime and a Disrupted Sleep Pattern Can Harm Officers' Health
A police officer who works the night shift, typically from 8 p.m. to 4 a.m., already is at a disadvantage when it comes to getting a good "night's" sleep.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
The benefits of exercise
Physical exercise is one of the most effective methods of preventing disease. The current issue of Deutsches Arzteblatt International is devoted to this important topic.
Heart and bone damage from low vitamin D tied to declines in sex hormones
Researchers at Johns Hopkins are reporting what is believed to be the first conclusive evidence in men that the long-term ill effects of vitamin D deficiency are amplified by lower levels of the key sex hormone estrogen, but not testosterone.
New study links vitamin D deficiency to cardiovascular disease and death
While mothers have known that feeding their kids milk builds strong bones, a new study by researchers at the Heart Institute at Intermountain Medical Center in Salt Lake City suggests that Vitamin D contributes to a strong and healthy heart as well - and that inadequate levels of the vitamin may significantly increase a person's risk of stroke, heart disease, and death, even among people who've never had heart disease.
Early end to key study on benefits of niacin, a B vitamin, in keeping arteries open was premature
Heart experts at Johns Hopkins are calling premature the early halt of a study by researchers at Walter Reed Army Medical Center and Washington Hospital Center on the benefits of combining extended-release niacin, a B vitamin, with cholesterol-lowering statin medications to prevent blood vessel narrowing.
Study finds many people with hemianopia have difficulty detecting pedestrians while driving, advocates for individual testing
Schepens Eye Research Institute scientists have found that--when tested in a driving simulator--patients with hemianopia (blindness in one half of the visual field in both eyes) have significantly more difficulty detecting pedestrians (on their blind side) than normally sighted people.
Texas Children's discharges first pediatric patient with implanted mechanical heart device
Texas Children's Hospital is the nation's first pediatric hospital to discharge a child while on an intracorporeal ventricular assist device (VAD), a feat previously accomplished only at adult institutions.
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