Intensive medical therapy for asymptomatic carotid stenosis has decreased the risk of stroke to such a degree that it has marginalized the benefits of revascularization in most patients, according to a retrospective study.
Intensive medical therapy, widely adopted after 2003, has cut the rate of microemboli to less than 4% and markedly reduced cardiovascular events, particularly stroke, in patients with asymptomatic carotid stenosis. It therefore should be considered the treatment of choice, said Dr. J. David Spence of the Stroke Prevention and Atherosclerosis Research Centre, London, Ont., and his associates.
Using data from a clinical trial documenting microemboli on transcranial Doppler imaging, they assessed 468 patients (mean age 70 years) with asymptomatic carotid stenosis. Subjects who were assessed during 2000–2002 (199 patients) were taking the less intensive medical therapy recommended at that time, whereas 269 patients assessed from January 2003 through July 2007 were taking the more aggressive medical therapy that is prevalent now.
The rate of microemboli was 13% before 2003, significantly higher than the 4% rate after 2003. Concomitantly, plasma lipid profiles steadily improved and the rate of carotid artery plaque progression markedly declined. More importantly, the rate of cardiovascular events dropped from 18% before 2003 to 5% afterward (Arch. Neurol. 20010;67[doi:10.1001/archneurol.2009.289]).
The study was funded by the Heart and Stroke Foundation of Ontario and the Stroke Prevention and Atherosclerosis Research Centre.