Carotid Surgery for Silent Stenosis Cuts Long-Term Stroke Risk

Medscape

For patients younger than 75 years with asymptomatic carotid stenosis, successful carotid endarterectomy (CEA) reduces the risk for stroke during the next 10 years by about 46%, with about half of this reduction in disabling or fatal strokes, suggest the Asymptomatic Carotid Surgery Trial 1 (ASCT-1) results published September 25 in The Lancet.

However, the perioperative risk for stroke or death is about 3%, note Allison Halliday, FRCS, of John Radcliffe Hospital, Oxford, United Kingdom, and colleagues. They conclude that "for otherwise healthy men and women younger than 75 years...the results from this trial suggest net benefit from CEA, as long as perioperative risks remain low."

In a written statement accompanying the study, Dr. Halliday noted that this trial took more than a decade to complete "because we wanted to know about the long-term effects of surgery. The finding that successful carotid artery surgery can substantially reduce the stroke risk for many years is remarkable because it means that most of the risk of stroke over the next 5 years in patients with a narrowed carotid artery is caused by that single carotid lesion."

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