Scientists from Kaiser Permanente found that the risk of having a stroke caused by a severe blockage in an artery in the neck that is not currently causing any symptoms is low in most patients.
The condition—asymptomatic carotid stenosis—could potentially be treated with the newest medications and may not require surgery.
The research is published in JAMA and was conducted by Robert Chang et al.
In the study, the team aimed to find out how likely is it that these patients will actually have a stroke related to their narrowed neck arteries.
The analyses showed that this risk is so low that it appears that, for most patients, surgery may not be necessary.
Carotid stenosis occurs when plaque—fatty cholesterol deposits—builds up in one or both of the large arteries on either side of the neck that carry blood to the brain, face, and head.
This narrowing in the artery is typically diagnosed after a patient has experienced symptoms of a stroke, but it can also be found during a routine physical examination.
The team examined 3,737 people with severe (70% to 99% blockage) asymptomatic carotid stenosis. None of these patients had previously had surgery.
Reviewing the patients’ medical records showed that 1,423 patients had had surgery to treat the stenosis, and 2,314 had not.
Overall, 133 strokes were diagnosed in 129 patients during the follow-up period.
The team showed that the patients who did not have surgery had a 4.7% risk of having a stroke within 5 years of their carotid stenosis diagnosis.
The findings showed a low risk of stroke in these patients because there are now better stroke-prevention treatments, including medications to control blood pressure, prevent blood clots, and reduce cholesterol.
This study will make many patients and their doctors think twice about surgery if they can instead be on an effective aggressive medical management program to lower their stroke risk from the asymptomatic carotid disease.
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