Carotid Occlusion ’NOT a Ticking Time Bomb'
Written by Editor   
Wednesday, October 28, 2015 02:55 PM

New evidence suggesting that carotid occlusion is not actually associated with a high risk for stroke.  The inference that many carotid stenting or endarterectomy procedures for asymptomatic patients therefore may do more harm than good is made in a new study.

Carotid occlusion is not the catastrophe that it is widely perceived to be.  Since intensive medical therapy has been introduced, the risk of occlusion has dropped dramatically and even if it does occur, the stroke risk is very low.  So trying to prevent carotid occlusion by surgery or stenting, which both carry significant risks themselves, is not a valid approach conclude the authors of the study.

The study showed that of the 316 patients who progressed to carotid occlusion, only 1 patient (0.3%) had a stroke at the time of the occlusion, and only 3 patients (0.9%) had a stroke during an average 2.5-year follow-up.

The researchers point out that this risk for stroke is far lower than that associated with carotid stenting or endarterectomy. They cite data from the CREST trial, which showed a 30-day risk for stroke or death among asymptomatic patients of 2.5% for stenting and 1.4% for endarterectomy and a 4-year risk of 4.5% and 2.7%, respectively.

They note that real-world data show even higher risks, with a study in Medicare patients having reported a 1-year rate of stroke or death of 16.7% for stenting and 11.0% for endarterectomy.

These latest data add to concerns about the safety of carotid stenting for asymptomatic carotid stenosis. This practice that is particularly prevalent in the United States, where financial incentives encourage interventional procedures.

The author of the medical study calls the practice of carotid stenting in asymptomatic patients "worse than unethical." He describes the situation in the United States as "deplorable." He commented: "In the US, 90% of carotid intervention is for asymptomatic stenosis, but 90% of patients with asymptomatic stenosis would be at lower risk with intensive medical therapy than with intervention.”