Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis.
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.
Abbott
Anne L
AL
Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia. a.abbott@nsri.org.au
D017130:Angioplasty / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D016893:Carotid Stenosis / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D018570:Risk Assessment; D020521:Stroke / Q000188:drug therapy* / Q000517:prevention & control* / Q000601:surgery
D000924:Anticholesteremic Agents