Journal
STROKE
Volume 40, Issue 10, Pages E573-E583Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/STROKEAHA.109.556068
Keywords
asymptomatic carotid stenosis; carotid endarterectomy; endovascular treatment; health policy; stroke prevention
Categories
Funding
- National Health and Medical Research Council Australian Research Fellowship [472700]
- Royal Australasian College of Physicians
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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. (Stroke. 2009;40:e573-e583.)
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