Stroke-Reducing Surgery Not Needed in Patients without Symptoms

The June 8, 2000 issue of The New England Journal of Medicine reports that endarterectomy, a high-risk surgery used to clear neck artery blockages may be unnecessary in patients who have blockages but no symptoms. In fact, say the researchers, endarterectomy can actually increase the risk of other types of stroke and related complications.

This study found that people who have blockages have a low risk of stroke if they are not experiencing any symptoms. In fact, patients with neck artery blockages between 60% and 99% only experienced a 16% risk of having a stroke. Also, 45% of the strokes that did occur in this group were of the type not helped by endarterectomy.

Researcher Dr. Henry Barnett of the John P. Robarts Research Institute in London, Ontario, Canada says that focusing on the four major factors for stroke, high blood sugar, high blood pressure, high cholesterol and smoking will provide more benefits to more patients than endarterectomy.

While noting that there may be patients without symptoms who would benefit from it, he noted that "the scales are tipped against the routine use of endarterectomy in patients who have no symptoms."

Barnett went on to say, "We have to look carefully at the enthusiasm with which the question of operating on asymptomatic arteries is embraced."