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Risk of Microemboli Reduced in Some Stenosis Patients

In patients with asymptomatic carotid stenosis, microemboli were linked to cardiovascular events

THURSDAY, Dec. 17 (HealthDay News) -- In patients with asymptomatic carotid stenosis (ACS), the presence of microemboli is associated with a greater risk of cardiovascular events, but intensive medical therapy may reduce the risk of microemboli, according to research published online Dec. 14 in the Archives of Neurology.

J. David Spence, M.D., of the Stroke Prevention and Atherosclerosis Research Centre in London, Canada, and colleagues analyzed data from 468 patients with ACS. Of these, 199 were enrolled in 2000 through 2002, and 269 were enrolled in 2003 or later, when intensive medical therapy for patients with plaque progression had been instituted.

The presence of microemboli, detected with transcranial Doppler, declined from 12.6 percent of patients before 2003 to 3.7 percent since. Patients with microemboli had substantially more stroke, myocardial infarction, carotid endarterectomy after developing symptoms, or death (32.4 versus 8.6 percent). Since 2003, these outcomes in patients with ACS decreased (17.6 percent before 2003 versus 5.6 percent since).

"We suggest that such intensive medical therapy be regarded as the first line of therapy for patients with ACS. Given that with intensive medical therapy, the risk of stroke in patients without microemboli is less than the risk of endarterectomy or stenting, we think that revascularization should be considered only for the rare patients with microemboli. Revascularization would only be appropriate in patients without microemboli if it could be done with a risk of less than 1 percent," the authors conclude.

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