Carotid artery surgery could substantially reduce stroke among high-risk patients

May 06, 2004

Results of an international study in this week's issue of THE LANCET suggest that surgery to widen narrowed carotid arteries could halve the risk of stroke among high-risk patients. However, authors of the study caution that surgery carries its own stroke risks if not done by experts.

There is currently debate as to whether people who have substantial narrowing of the carotid arteries (but who have not had a recent stroke or transient ischaemic attack) should undergo carotid endarterectomy (CEA)-a complex surgical procedure to widen the carotid arteries which itself carries a risk of stroke.

The UK Medical Research Council (MRC) Asymptomatic Carotid Surgery Trial (ACST) is a ten-year prospective study involving 3120 patients from 126 hospitals in 30 countries. Half the patients were allocated to CEA, the other half to no intervention. Many of the patients were receiving medical therapy (anti-hypertensives, anticoagulants, and cholesterol-lowering drugs). Average follow-up of patients was 3•4 years.

The risk of stroke or death from surgery was 3%. The 5-year risk of stroke among patients younger than 75 years given CEA was around half that of patients given no intervention (6% [including the 3% surgical hazard] compared with 12%). Half this 5-year benefit involved disabling or fatal strokes. However, the investigators caution that 'outside trials, inappropriate selection of patients or poor surgery could obviate such benefits'.

Lead author Alison Halliday from St Georges Hospital, London, UK, comments: "Our trial shows that immediate surgery is the best option for some patients with severe narrowing of the carotid artery. How much this changes practice will depend on how long the benefits last, so we are going to follow up these patients for another 5 years to find this out." (quote by e-mail, does not appear in published study).

In an accompanying Commentary (p 1486), Henry Barnett from the John Roberts Research Institute, Ontario, Canada, concludes: "Problems persist, but the investigators of the ACST are to be congratulated for performing well a monumental task. They are to be commended for their cautionary concluding remarks. Carotid endarterectomy with any less skill than exhibited by ACST and ACAS surgeons quickly casts the procedure into the list of "risk factors for stroke"."
Contact: MRC Press Office, Park Crescent, London W1, UK; T) 44-0-20-7637-6011; E) Dr. Henry J M Barnett, The John P Robarts Research Institute, PO Box 5015, 100 Perth Drive, London, Ontario N6A 5K8, Canada; T) 519-663-3678; E)


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 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