Carotid endarterectomy for asymptomatic carotid stenosis

Article Abstract:

The effectiveness of carotid endarterectomy in lowering the risk of stroke among patients with asymptomatic carotid stenosis remains questionable. Carotid stenosis is a narrowing of the carotid artery, and endarterectomy is the surgical removal of the thickened portion of the artery. This procedure has been proposed as a means of preventing stroke. A randomized trial of about 2,000 patients with symptomatic carotid stenosis found that surgery in addition to medical care was more effective than medicine alone in reducing the risk of strokes. Studies among patients with asymptomatic carotid stenosis though, have produced mixed results. One recent study found endarterectomy lowered the overall risk of a neurologic event such as stroke, monocular blindness or ischemic attack. However, the risk of stroke alone was only slightly lower among patients undergoing surgery, which is potentially harmful in itself, and surgery did not reduce the risk of stroke and death combined. Until further studies are conducted, daily aspirin therapy is recommended for patients with asymptomatic carotid stenosis.

Editorial, Evaluation

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Primary prevention of stroke

Article Abstract:

Efforts should be made to reduce the various risk factors for stroke. Hypertension should be treated, as it may increase the risk of stroke by as much as 10 times. Smoking may increase the risk of stroke by 1.5 times, and this risk appears to drop after people stop smoking. Diabetes also appears to contribute to the risk of stroke, but rigid control of blood sugar levels may or may not affect this risk. Obesity may indirectly contribute to the risk of stroke by increasing other risk factors, such as hypertension. High levels of total cholesterol may increase the risk of certain kinds of stroke, while reducing the risk of other kinds of stroke. The effects of alcohol, fat, fatty acids, and vitamins on the risk of stroke are not completely clear. Similarly, the risks of female oral contraceptives and hormone therapy are not definitively known. Aspirin may reduce the risk of stroke caused by blood clots, but increase the risk of stroke caused by hemorrhage. Physical activity appears to reduce risk.

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The fall and rise of carotid endarterectomy in the United States and Canada

Article Abstract:

The use of carotid enarterectomy for prevention of stroke declined dramatically through the mid- to late 1980's, and has risen again from 1989 through 1995. This procedure should be done in surgically excellent cetners, and in the 80's, the unaccaptibly high rates of complications cause a rapid drop in the number of procedures done. Clinical trials done in the 1990s showed enough potential benefit from the procedure to bring about a new increase in use. Selective referral to surgical centers with low mortality rates has not been instituted, raising the question of the differences in mortality between real life practice and clinical trials.

Health aspects

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