Fewer patients undergoing stroke prevention surgery for wrong reasons

January 15, 2007

ST. PAUL, Minn -- A new study has found a drop in the number of patients undergoing the most commonly used stroke prevention surgery, carotid endarterectomy, for inappropriate reasons. Researchers are crediting the drop to highly publicized randomized controlled trials (RCTs) that clarified the appropriate use of the surgery. The researchers' findings are published in the January 16, 2007, issue of Neurology®, the scientific journal of the American Academy of Neurology.

The New York Carotid Artery Surgery (NYCAS) study evaluated the appropriateness of 9,588 carotid endarterectomy surgeries performed on elderly patients in New York state. Carotid endarterectomy is a surgical procedure that involves opening up the artery in the neck that supplies blood to the brain and removing harmful plaque build-up that can cause a stroke.

The NYCAS study found the rate of inappropriate carotid endarterectomy surgeries among the elderly dropped substantially from 32 percent in the landmark RAND Health Services Utilization Study in 1981 before the RCTs to 8.6 percent in the present study's evaluation of New York cases in the period after publication of the trials. It was the RAND study's findings that prompted several larger international clinical trials to clarify when it is appropriate to perform a carotid endarterectomy.

"Though RCTs are time-consuming, expensive, and logistically challenging, our findings suggest that they played a role in improving the appropriate use of carotid endarterectomy," said the study's author Ethan Halm, MD, MPH, an Associate Professor at The Mount Sinai School of Medicine in New York, New York.

The most common reason the procedures were determined to be inappropriate in the current study was because patients with no symptoms from the blocked arteries were at high risk of surgical complications due to the presence of several other major medical problems. This subgroup of patients had more than twice the risk of death or stroke due to the surgery compared to those without other diseases.

"The good news is following the large public investment in medical research on who should undergo carotid endarterectomy, there's been a large reduction in the number of patients undergoing the procedure for inappropriate reasons. The bad news is there's been a shift towards operating predominantly on patients with no symptoms from the blocked arteries where the benefit from surgery is lower and is reduced further for patients with other medical conditions," said Halm.
-end-
EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, MONDAY, JANUARY 15, 2007 Media Contact: Robin Stinnett, rstinnett@aan.com, (651) 695-2763

The study was supported by the federal Agency for Healthcare Research and Quality, Center for Medicare & Medicaid Services, and the Robert Wood Johnson Foundation.

The American Academy of Neurology recently updated its guideline on carotid endarterectomy. For more information, visit www.aan.com.

The American Academy of Neurology, an association of more than 20,000 neurologists and neuroscience professionals, is dedicated to improving patient care through education and research. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer's disease, epilepsy, Parkinson disease, and multiple sclerosis. For more information about the American Academy of Neurology, visit www.aan.com.

American Academy of Neurology

Related Stroke Articles from Brightsurf:

Stroke alarm clock may streamline and accelerate time-sensitive acute stroke care
An interactive, digital alarm clock may speed emergency stroke care, starting at hospital arrival and through each step of the time-sensitive treatment process.

Stroke patients with COVID-19 have increased inflammation, stroke severity and death
Stroke patients who also have COVID-19 showed increased systemic inflammation, a more serious stroke severity and a much higher rate of death, compared to stroke patients who did not have COVID-19, according a retrospective, observational, cross-sectional study of 60 ischemic stroke patients admitted to UAB Hospital between late March and early May 2020.

'Time is vision' after a stroke
University of Rochester researchers studied stroke patients who experienced vision loss and found that the patients retained some visual abilities immediately after the stroke but these abilities diminished gradually and eventually disappeared permanently after approximately six months.

More stroke awareness, better eating habits may help reduce stroke risk for young adult African-Americans
Young African-Americans are experiencing higher rates of stroke because of health conditions such as high blood pressure, diabetes and obesity, yet their perception of their stroke risk is low.

How to help patients recover after a stroke
The existing approach to brain stimulation for rehabilitation after a stroke does not take into account the diversity of lesions and the individual characteristics of patients' brains.

Kids with headache after stroke might be at risk for another stroke
A new study has found a high incidence of headaches in pediatric stroke survivors and identified a possible association between post-stroke headache and stroke recurrence.

High stroke impact in low- and middle-income countries examined at 11th World Stroke Congress
Less wealthy countries struggle to meet greater need with far fewer resources.

Marijuana use might lead to higher risk of stroke, World Stroke Congress to be told
A five-year study of hospital statistics from the United States shows that the incidence of stroke has risen steadily among marijuana users even though the overall rate of stroke remained constant over the same period.

We need to talk about sexuality after stroke
Stroke survivors and their partners are not adequately supported to deal with changes to their relationships, self-identity, gender roles and intimacy following stroke, according to new research from the University of Sydney.

Standardized stroke protocol can ensure ELVO stroke patients are treated within 60 minutes
A new study shows that developing a standardized stroke protocol of having neurointerventional teams meet suspected emergent large vessel occlusion (ELVO) stroke patients upon their arrival at the hospital achieves a median door-to-recanalization time of less than 60 minutes.

Read More: Stroke News and Stroke Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.