Think twice before having carotid artery surgery

Hundreds of thousands of people have undergone surgery or stents to “fix” blockages in their carotid arteries. (The left and right carotids are the main arteries to the brain.) Most of the these people (about 90%) reported no complaints. We say they are asymptomatic. The blockages were discovered on exam or by ultrasound of the neck. The idea is that major blockages can progress to full blockages and cause stroke. Since it’s best to prevent stroke, patients with blockages get referred to surgeons and surgeons operate. The fix entails cleaning out the blockage, which we call endarterectomy. More recently, carotid stents (think cardiac stents, only bigger) have been used. Sounds good, right? It turns out that a look at the evidence in support of preventive carotid surgery is weak and outdated. (Note…There is no debate over intervention in patients with symptoms.) Two trials, one done in the 1980s, the other in 1990s, showed surgery to have a slight superiority to medical treatment. Think about that for a moment. Medical therapy in the 1980s barely included statins. Yet, even against ancient medical therapy, surgery barely won. Annually, the number of patients needed to treat (NNT) with surgery to prevent one stroke on the side of the blockage was 100. That means 99 out of 100 with carotid blockages have surgery without benefit. The problem, of course, is that surgery does not come free–the complication rate ranges from 2-3% in the best of hands. Re...
Source: Dr John M - Category: Cardiology Authors: Source Type: blogs