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WSC: Surgery Questioned for Asymptomatic Carotid Stenosis

Researchers conclude that optimal medical management is sufficient in 96 percent of patients

THURSDAY, Sept. 25 (HealthDay News) -- Because intensive medical therapy has dramatically reduced the risk of stroke in patients with asymptomatic carotid stenosis, surgery or stenting is not necessary in the vast majority of cases, according to research presented at the 6th World Stroke Congress held Sept. 24 to 27 in Vienna, Austria.

J. David Spence, M.D., of the Robarts Research Institute in London, Ontario, Canada, and colleagues studied 471 patients who underwent transcranial Doppler embolus detection (199 before 2003 and 272 after Jan. 1, 2003).

Between the two time periods, the researchers found that the number of patients with microemboli declined from 12.6 percent to 3.7 percent, which they attributed to improved lipid control and slower progression of carotid plaque. Since 2003, they also observed a significant decline in strokes and heart attacks in patients with asymptomatic carotid stenosis.

"The 96 percent of patients without microemboli have only a 1 percent risk of stroke in the next year, whereas the ones with microemboli have a 14 percent risk of stroke," Spence said in a statement. "Since the risk of surgery is 4 to 5 percent, patients without microemboli are better off with medical therapy including medications and lifestyle modifications. Only the ones with microemboli would benefit from carotid endarterectomy or stenting."

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