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Updated guideline: Carotid endarterectomy beneficial for stroke prevention in some patients

September 27, 2005

ST. PAUL, Minn. - Stroke affects more than 700,000 people in the United States per year. A blockage of a blood vessel is responsible for about 80 percent of strokes. Carotid endarterectomy is the most frequently performed operation to prevent stroke. There is scientific evidence to support its use to prevent future stroke, according to a clinical practice guideline published in the September 27, 2005 issue of Neurology, the scientific journal of the American Academy of Neurology (AAN). The guideline updates the 1990 AAN statement on carotid endarterectomy.

Carotid endarterectomy is a surgical procedure that removes plaque and fatty deposits from blocking the carotid arteries which are the main suppliers of blood for the brain. There is strong evidence recommending carotid endarterectomy to prevent stroke in people who have severe (70 to 99 percent) blockage in their carotid artery. Nearly 25 percent of people who recover from their first stroke will have another stroke within five years. The guideline authors reviewed all of the scientific evidence on carotid endarterectomy.

The guideline found that carotid endarterectomy is effective for patients with severe stenosis (narrowing in a carotid artery) and recent symptoms of stroke or transient ischemic attack (TIA or mini-stroke). Carotid endarterectomy may also be considered for patients with moderate (50 to 69 percent) stenosis and recent symptoms of stroke.

For people between the ages of 40 - 75 years with moderate to severe narrowing, but presenting with no symptoms of stroke or disease, carotid endarterectomy may be considered if the patient has at least a five-year life expectancy and if the surgery can be done with a low complication rate.

"The evidence of this guideline points out an effective method of stroke prevention in certain people," said Seemant Chaturvedi, MD, guideline author and director of the Wayne State University Stroke Program. "Carotid endarterectomy is beneficial for those with severe to moderate narrowing in their carotid artery."

For patients with less than 50 percent stenosis, medical treatment is preferred over carotid endarterectomy.

People who undergo carotid endarterectomy should receive low-dose aspirin therapy (81 to 325 mg per day) prior to surgery and for at least three months following surgery, according to the guideline.

There is not enough evidence for or against having a carotid endarterectomy within four to six weeks of a moderate to severe stroke.

"We recommend further high-quality studies to evaluate the evidence/practice gap in the future," said Chaturvedi.

The guideline will be available online on September 27 at http://www.aan.com/professionals/practice/guideline/index.cfm

American Academy of Neurology