Surgery May Not Help Most People With Narrowed Brain Artery

Intensive medical treatment can prevent stroke, study says

By Ed Edelson
HealthDay Reporter

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THURSDAY, Sept. 25 (HealthDay News) -- The vast majority of people at risk of stroke because the main artery to the brain is partially blocked but have no symptoms are better off if they don't have surgery to restore blood flow, a new study contends.

"Above 95 percent of patients with asymptomatic carotid stenosis can benefit if they receive intensive medical therapy rather than endarterectomy [the surgical removal of plaque from a blocked artery] or stenting," said study leader Dr. David Spence. He is director of the Stroke Prevention & Atherosclerosis Research Centre at the Robarts Research Institute at the University of Western Ontario in Canada.

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A simple test can identify the small percentage of people with symptomless partial blockage of the carotid, the main artery to the brain, who are at high risk of stroke and should have the surgical procedure endarterectomy or implantation of a stent, a metal tube to maintain blood flow, Spence said.

He was expected to present the study findings Sept. 25 at the Sixth World Stroke Congress, in Vienna, Austria.

Endarterectomy for symptom-free carotid stenosis is greatly overused in the United States, Spence said. "In the United States, between half and two-thirds of these procedures are done for asymptomatic carotid stenosis," he said. "In Australia, it is between 10 and 20 percent."

Intensive medical therapy, including "exercise, the Mediterranean diet, statin doses up to the maximum regardless of LDL (bad) cholesterol level, ACE inhibitors, niacin, whatever we can do to reduce plaque," can make the risk of stroke negligible in such cases, Spence said.

"Since 2003, only 0.8 percent of patients with asymptomatic stroke have had a stroke in the first year, and zero percent have heart attacks in the first year," he added.

The year 2003 can be used as a dividing line, because medical therapy has become much more effective since then, Spence said. A study of a diagnostic procedure called transcranial Doppler embolism detection helped prove the point, he said.

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