The dilemma of surgical treatment for patients with asymptomatic carotid disease
Article Abstract:
Carotid endarterectomy in asymptomatic patients may not be as safe as suggested by the Asymptomatic Carotid Artery Study (ACAS). The five-year reduction of stroke risk was 5.9%, which is a modest reduction. People who had surgery had the same stroke rate as those taking medical treatment alone. In addition, women in the study did not benefit from endarterectomy. Patients must be aware that surgery will not reduce their risk of major stroke after the surgical procedure. The modest results from ACAS do not warrant a generalization to all patients with a stenosis of 60% and above. Therefore, conclusions on the benefits of asymptomatic carotid endarterectomy cannot be drawn at this point. Hopefully, ACAS will not prompt an increase of unsuitable procedures until further analysis is completed.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1995
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Medical compared with surgical treatment of asymptomatic carotid artery stenosis
Article Abstract:
Carotid endarterectomy combined with risk reduction and aspirin may prevent stroke more effectively than medical treatment alone, according to a recent Asymptomatic Carotid Atherosclerosis Study (ACAS). Surgical endarterectomy removes the plaque accumulated in arteries. The ACAS followed 1,662 patients with a stenosis, or narrowing, of the carotid artery of more than 60 percent. The risk of stroke after surgery is lower for patients without symptoms than for symptomatic patients. General screening of the population is therefore not necessary. Mortality and stroke rate in the ACAS group approached 2.3%, a significant improvement over previous results. Surgery is recommended for patients with a stenosis of more than 60%, a low risk profile, and a life expectancy of at least five years.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1995
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The antiplatelet effects of ticlopidine and clopidogrel
Article Abstract:
Ticlopidine and clopidogrel are recently approved antiplatelet drugs used to prevent, stroke, blood vessel blockage, vascular stenosis, and other clot-related medical conditions. Both medications inhibit the aggregation of blood platelets, reducing clot integrity and formation. Compared to aspirin, which has a similar antiplatelet effect, these drugs more effectively reduce the incidence of stroke, arterial restenosis after coronary stenting, and other clotting events. However, they increase the risk of bleeding, and they are substantially more expensive than aspirin therapy.
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1998
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