Surgery can halve the risk of stroke
Lancet 2004; 363: 1491-502
Most strokes occur when a blood clot blocks an artery that carries blood to the brain. Research funded by The Stroke Association has shown that surgery may halve the risk of a stroke for people who have a substantial narrowing of the main arteries to the brain. However, over 200,000 patients in the UK and Europe may be missing out on the benefits that surgery could bring because of delays in treatment.
The main arteries which carry blood to the brain are called the carotid arteries. These are located on each side of the neck. The walls of the carotid arteries may become built up over time with fatty deposits (cholesterol) and other debris. This causes the arteries to narrow which means that less blood can travel through them, increasing the chance of a blood clot. People who have a substantial narrowing of the carotid arteries are known to be at increased risk of stroke.
Carotid endarterectomy is the name of the surgical procedure used to remove the build up of fatty deposits in the carotid artery, thereby reducing the chance of a blood clot. Doctors have been uncertain whether carotid endarterectomy has a clear long-term benefit for patients with narrowing of the carotid arteries, when compared with the risks of the surgery itself. For this reason the surgery has only been recommended for people with very severe arterial damage, to ensure that the risk of causing a stroke as a result of the operation is lower than the risk of a stroke if nothing is done.
Funded by The Stroke Association, Miss Alison Halliday and others at St George’s Hospital Medical School have found that carotid endarterectomy surgery can halve the risk of a stroke for people who have substantial narrowing of the carotid artery. The trial compared immediate surgery for patients who had severe narrowing of the carotid artery with deferred surgery. Over 3,000 patients in 30 countries took part in the study. The trial found that, after five years, people aged 75 and under who had immediate surgery halved their risk of stroke from 12 per cent to 6 per cent.
Changes in health service practice will depend on whether these benefits continue beyond five years, as most patients under 75 will survive 10 years. Therefore The Stroke Association is funding the Asymptomatic Carotid Surgery Trial (ACST) -10-year results. The results of this project will help determine whether the operation is effective.
Further details of the project and findings are outlined in the Stroke News Summer 2004 article (197 kb) ![[pdf]](/display_images/document_icons/pdf.gif){kind=icon}
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Press Release 07.09.04 - Trial finds surgery can halve the risk of stroke (results 5 years into ACST trial)
