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Should Asymptomatic Carotid Artery Stenosis Be Treated?

Posted Dec 23 2011 12:00am

Whether or not patients with asymptomatic carotid artery stenosis should be treated remains a greatly debated topic among medical professionals. While there is no clear cut answer just yet, the conversation continues among experts and new research studies are offering fresh insights to how to best prevent stroke from this type of heart disease.

Carotid artery stenosis is a sign of cardiovascular diseases in which the inside of the carotid artery becomes narrow and hardened, narrowing the passageway for blood to flow to the brain. If left untreated, the narrowing or damage can become so severe that either the blood flow becomes completely occluded, or a piece of the plaque on the arteries breaks off and becomes lodged in the brain – causing a stroke.
Currently the US Preventative Task Services recommends against routine screening for carotid artery stenosis in adults, meaning that many do not know that they have this disease until they become symptomatic. However, if the stenosis is discovered inadvertently while the patient is asymptomatic – there is considerable debate on which, if any, carotid artery stenosis treatment should be used.
According to Dr. Anne Abbot, neurologist and senior research fellow at the Baker IDI Heart and Diabetes Institute in Melbourne, Australia, it has previously been believed that surgical intervention for this disease was more effective than medical management (medications, lifestyle changes, etc.). Surgical interventions include carotid artery stenting and carotid revascularization endarterectomy However, she argues that with advances in available less invasive management techniques this belief should be re-evaluated.
“Older randomized trials had shown that surgery was superior to medical management in asymptomatic patients, but these studies did not take into account modern medical management, and also we had no accurate data on risks with medical management alone.”said Abbot. “Best medical treatment for asymptomatic carotid stenosis needs to be clarified and revisited in our current era. And once it is defined, we need to measure the impact on the whole vascular tree and on [stroke] prevention

More discussion on management of asymptomatic carotid artery stenosis will continue at the International Symposium on Endovascular Therapy (ISET) which will be held January 15-19, 2012 at the Fontainebleau Miami Beach in Florida.
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