Does current medical intervention alone prevent stroke in patients with asymptomatic severe carotid stenosis as effectively as surgery?
Current medical intervention alone is more cost-effective and provides comparable stroke prevention to surgery for asymptomatic severe carotid stenosis, challenging the routine use of surgical intervention.
Significant advances in vascular disease medical intervention since large randomized trials for asymptomatic severe carotid stenosis were conducted (1983-2003) have prompted doubt over current expectations of a surgical benefit. In this systematic review and analysis of published data it was found that rates of ipsilateral and any-territory stroke (+/-TIA), with medical intervention alone, have fallen significantly since the mid-1980s, with recent estimates overlapping those of operated patients in randomized trials. However, current medical intervention alone was estimated at least 3 to 8 times more cost-effective. In conclusion, current vascular disease medical intervention alone is now best for stroke prevention associated with asymptomatic severe carotid stenosis given this new evidence, other cardiovascular benefits, and because high-risk patients who benefit from additional carotid surgery or angioplasty/stenting cannot be identified.
Anne L. Abbott (Thu,) studied this question.