Stroke prediction and prevention by carotid endarterectomy: keep an eye on the doughnut and not just the hole.
Carotid endarterectomy is currently indicated for patients with severe symptomatic carotid stenosis because it halves the risk of stroke. However, it is expensive and potentially risky, and is performed unnecessarily in most of these patients. In order to improve the cost effectiveness of carotid endarterectomy, other predictors of stroke, in addition to the presence of recent focal neurological symptoms and the degree of carotid stenosis, need to be identified. Further research into the nature of the carotid atherosclerotic plaque and the clustering of systemic factors (infectious, inflammatory and vascular risk factors) that trigger inflammatory and morphological changes in the asymptomatic plaque and predispose it to rupture (with subsequent symptomatic thromboembolism) may yield powerful predictors of stroke which, when combined with the degree of stenosis and presence of focal neurological symptoms, may improve patient selection for carotid endarterectomy and its cost effectiveness.
Hankey
G J
GJ
Stroke Unit, Royal Perth Hospital and University of Western Australia, Perth, W.A., Australia. gjhankey@cyllene.uwa.edu.au
D001161:Arteriosclerosis / Q000150:complications; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000150:complications; D002544:Cerebral Infarction / Q000517:prevention & control; D016894:Endarterectomy, Carotid; D006801:Humans; D011237:Predictive Value of Tests; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control*