Medical therapy lowers stroke risk, better than surgery


Toronto : Intensive medical therapy, including medications and modified lifestyle, lowers stroke risks and is better than surgery or stenting, according to a new Canadian study.

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Stenting is a medical procedure in which a small, expandable wire mesh or stent is implanted into the diseased artery to act as a scaffold to help it stay open and let the blood pass.

David Spence, research leader and professor of neurology and clinical pharmacology at the University of Western Ontario in Waterloo near here, says intensive medical therapy lowers the risk of stroke to such an extent that at least 95 percent of patients with asymptomatic carotid stenosis (ACS) would be better off with medical therapy than with surgery or stenting.

In medical parlance, ACS refers to a narrowing in the carotid artery (which supplies blood to the brain) that has not yet resulted in a stroke – also called transient ischemic attack (TIA).

Whether the remaining less than five percent of ACS patients would benefit from surgical procedure can be identified with a process called Transcranial Doppler Embolus Detection, according to Spence.

In this procedure, a helmet is placed on the head to hold ultrasound instruments to monitor arteries inside the head for microemboli or fat particles, small blood clots or chunks of plaque that break off from the narrowing in the carotid artery and go into the brain arteries.

As part of their research, Spence and his team of researchers studied 471 ACS patients. Of those, 199 were subjected to intense medical therapy before 2003 and 272 after Jan 1, 2003.

Spence said microemboli or fat particles were present in 12.6 percent of patients before 2003, but in only 3.7 percent since 2003. The decline in microemboli was attributed to better control of plasma lipids (fatty acids, cholesterol, etc) and slower progression of carotid plaque through intense medical therapy.

As a result, he said, there were significantly fewer strokes and heart attacks among those treated since 2003.

“The 96 percent of patients without microemboli have only a one percent risk of stroke in the next year, whereas the ones with microemboli have a 14 percent risk of stroke,” said Spence.

“Since the risk of surgery is four to five percent, patients without microemboli are better off with medical therapy including medications and lifestyle modifications. Only the ones with microemboli would benefit from carotid endarterectomy or stenting,” he added.

Spence presented his findings at the sixth World Stroke Congress in Vienna Thursday.