Today at the 37th Annual VEITHsymposium in New York, a recent study of the risk of stroke among patients showing moderate to severe internal artery narrowing, but no other symptoms, indicated that 99% of the time, invasive methods for determining the risk of stroke are unnecessary.
The results of the study, conducted by the International University of America in London were reported by Andrew Nicolaides, MD, Professor of Vascular Surgery (Emeritus), Imperial College, London, UK, at the New York Hilton (NY, NY).
Dr. Nicolaides reported that invasive determination for the annual risk of one-sided cerebral stroke in these patients is necessary in only 1% of them, making routine carotid endarterectomy unjustified. The procedure, however, may be justified for patient subgroups showing sufficiently higher symptoms and risk, despite optimal medical intervention.
Dr. Nicolaides reported, “1121 patients with asymptomatic blockage of 50-99% in relation to the bulb (ECST method) were followed-up for an average of 48 months.
A total of 130 ipsilateral CORI events occurred. Severity of stenosis, age, systolic blood pressure, increased serum creatinine, smoking history, history of contralateral TIAs or stroke, low gray scale median (GSM), increased plaque area, plaque types 1, 2 and 3 and presence of discrete white areas without acoustic shadowing (DWA) were associated with increased risk.”
Nicolaides stated it was determined that viewing a layered configuration of deposits of fatty material in the inner lining of an arterial wall, characteristic of atherosclerosis, is possible using a combination of clinical and ultrasonic plaque features.
User-friendly software is now available for calculating risk. Most important are the training in equipment settings and image capture such as imaging plaques with the beam of ultrasound at right angles to the vessel wall and minimal noise in the cavity of the blood vessel.
Dr. Nicolaides added, “Only 1% of patients with moderate to severe asymptomatic internal carotid narrowing required more than optimal medical intervention alone, making routine carotid endarterectomy unjustified.
However, if patient subgroups with sufficiently higher average risk, despite current optimal medical intervention, could be reliably identified, then carotid surgery may still be justified,” concluded Nicolaides.
Source: VEITHsymposium