Artery Clearing Surgery May Prevent a Stroke

Procedure seems to benefit even those without symptoms

Having surgery to clean out deposits that have narrowed the main artery to the brain apparently can help prevent a stroke.

There's been general agreement that the surgery -- known as carotid endarterectomy -- is needed for people who have obvious problems, such as those who've had a minor stroke, Dr. Alison Halliday, a consultant vascular surgeon at St. George's Medical School in London, told HealthDay. But whether surgery would help people whose carotid narrowing was discovered before they have symptoms had been controversial.

That issue appears to have been settled, said Dr. James Toole, a professor of neurology at Wake Forest University Baptist Medical Center. Both a small American study led by Toole and a subsequent and larger British study led by Halliday produced similar results.

Only 6 percent of people who had a serious blockage -- but no symptoms -- and who had a carotid endarterectomy suffered strokes over the next five years, compared with 12 percent of those with the same condition who did not have the surgery, the British report said.

"We think the balance of risk is strongly in favor of surgery," Halliday told HealthDay.

The results are similar to those from Toole's study, conducted from 1987 to 1993, but the British study had nearly twice the number of participants -- 3,120 compared with 1,662.

"The data we had were very suggestive, but skeptics said a larger study of longer duration was needed," Toole told HealthDay.

"We actually began our study before his study was reported," Halliday said. "After that report, we sat down and discussed the results. We decided that there was not sufficient evidence to know whether the operation would be of value from a European perspective, so we decided to recruit a larger number of patients."

The big difference in the two studies was that Toole's group found a benefit for men but not women; Halliday's study found similar benefits for both sexes. One explanation is that the British trial included a large enough group of women to show a benefit, Halliday said.

Together, the studies have shown that carotid endarterectomy should be considered for anyone whose artery has been narrowed by 60 percent or more, Toole said.

However, the person need not be rushed into surgery, he added, because there are other ways to improve blood flow through the carotid artery.

A person with a blockage of 60 percent or more, but with no symptoms, should be told to take aspirin and a cholesterol-lowering drug to reduce their blood pressure, and to stop smoking if they do, Toole said.

"I would give it six months and have the test again to see if the blockage has gone away," he said. "The condition can get better. If it does not, surgery should be considered."

But the news isn't all good.

The British results revealed that age might be an issue, Halliday said. The study found no benefit from surgery for people aged 75 or older.