Improved diagnostics could reduce risky surgery for asymptomatic carotid stenosis

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New Canadian research has shown that using 3D ultrasound to identify ulcers in the carotid arteries is an effective way to pinpoint the small number of high-risk patients with asymptomatic carotid stenosis who would benefit from surgery to prevent stroke. The research is published in the 17 August online issue of Neurology, the medical journal of the American Academy of Neurology.

In the three-year study of 253 asymptomatic carotid stenosis patients (mean age 69.66 years), researchers found that if three or more ulcers were found in the carotid arteries using 3D ultrasound, the patient was at high risk of stroke and could benefit from intervention. Researchers compared to the proven transcranial Doppler which detects pieces of microemboli breaking off and entering the blood stream, and found both identified those asymptomatic carotid stenosis patients most at risk of having a stroke. 

Surgical interventions such as stenting and endarterectomy carry their own risks and costs. “Now we have developed two ways to identify the few who could benefit from surgery or stenting,” said David Spence, co-author of the study, professor in the Department of Clinical Neurological Sciences at Western’s Schulich School of Medicine and Dentistry and a scientist in its Robarts Research Institute in Ontario, Canada. “The reason it is important is that in the United States 90 to 95% of carotid endarterectomy and stenting are being done for asymptomatic carotid stenosis even though it is not warranted for the vast majority of them. I hope this study would influence those decisions.”

 

Spence showed in earlier studies (2005) that 90% of patients with asymptomatic carotid stenosis were better off being treated with medical therapy. With more intensive medical therapy, the proportion that could benefit from intervention had declined by 2010 to less than 5%.

The study was funded by the Heart and Stroke Foundation of Canada. “Thanks to this effort, we are that much closer to providing ways to improve system care for stroke patients,” said Manuel Arango, director, Health Policy, Heart and Stroke Foundation of Canada.

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