Succinct review suggests that medical management is superior to CEA for asymptomatic carotid stenosis

Key Research in Medical Specialty Areas: Journal Watch Specialties

A few quotes from a review by — Allan S. Brett, MD:

Because medical therapy has improved since these trials were conducted, researchers have examined whether stroke rates in patients with ACS have declined during the past decade. In fact, rates have fallen to around 1% annually in medically treated patients.4,5

Thus, we must ask whether CEA has any role in patients with ACS. Recently, researchers have proposed several imaging findings that might identify high-risk subgroups — plaque echolucency, plaque ulceration, and embolic signals on transcranial Doppler ultrasound of the ipsilateral middle cerebral artery…

Thus, many asymptomatic patients who now undergo CEA (or carotid stenting, which is not safer than CEA) are likely risking harm without commensurate benefit. Use of embolic signals and plaque characteristics to identify candidates for CEA is promising but requires larger studies and assurance that the techniques are reliable in community settings.
I couldn’t agree more!

4. Marquardt L et al. Low risk of ipsilateral stroke in patients with asymptomatic carotid stenosis on best medical treatment: A prospective, population-based study. Stroke 2010 Jan; 41:e11. (http://dx.doi.org/10.1161/STROKEAHA.109.561837)

5. Abbott AL. Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: Results of a systematic review and analysis.Stroke 2009 Oct; 40:e573. (http://dx.doi.org/10.1161/STROKEAHA.109.556068)

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