This Article Full Text Full Text (PDF) CME: Take the course for this article: Stroke: October 2009, Volume 40, Number 10 All Versions of this Article: 40/10/e573    most recent STROKEAHA.109.556068v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Google Scholar Articles by Abbott, A. L. PubMed PubMed Citation Articles by Abbott, A. L. Pubmed/NCBI databases Medline Plus Health Information Stroke Transient Ischemic Attack Related Collections Health policy and outcome research Carotid Stenosis Carotid endarterectomy Angioplasty and Stenting

(Stroke. 2009;40:e573.)
© 2009 American Heart Association, Inc.

Topical Review

Medical (Nonsurgical) Intervention Alone Is Now Best for Prevention of Stroke Associated With Asymptomatic Severe Carotid Stenosis

Results of a Systematic Review and Analysis

From the Baker IDI Heart & Diabetes Institute, and the National Stroke Research Institute (at Austin Health), both in Melbourne, Victoria, Australia.

Correspondence to Dr Anne Abbott, Baker IDI Heart & Diabetes Institute, PO Box 6492, St Kilda Road Central, VIC 8008 Australia. E-mail a.abbott{at}nsri.org.au

Larry B. Goldstein MD Peter M. Rothwell PhD, FRCP, FMedSci Section Editors:

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.

Key Words: asymptomatic carotid stenosis • carotid endarterectomy • endovascular treatment • health policy • stroke prevention