Our Summary

This study aimed to determine the best treatment for patients with asymptomatic carotid artery stenosis, a condition where the carotid arteries (major blood vessels that supply blood to the brain, neck, and face) become narrowed. The researchers compared three treatment options: carotid endarterectomy (CEA) plus best medical treatment (BMT), carotid artery stenting (CAS) plus BMT, and BMT alone. CEA is a surgical procedure to remove plaque from the carotid artery, while CAS is a less invasive procedure where a stent is inserted to widen the artery.

513 patients in Austria, Germany, and Switzerland were randomly assigned to one of the three treatments. They were then followed for just under 5 years. The researchers were primarily looking at the number of patients who had a stroke or died within 30 days of treatment, or who had a stroke on the same side as their stenosis within 5 years.

The results showed no significant difference between the three treatment options in terms of these outcomes. However, the researchers caution that the study had a small sample size and recruitment was slower than expected, so the results should be interpreted carefully.

The study was funded by the German Federal Ministry of Education and Research and the German Research Foundation.

FAQs

  1. What is carotid endarterectomy (CEA) and carotid artery stenting (CAS)?
  2. What were the key findings of the study comparing three treatment options for asymptomatic carotid artery stenosis?
  3. Why should the results of this study be interpreted carefully?

Doctor’s Tip

A helpful tip a doctor might tell a patient about carotid endarterectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and making lifestyle changes such as quitting smoking and maintaining a healthy diet and exercise routine to reduce the risk of future plaque buildup in the carotid arteries.

Suitable For

Patients who are typically recommended for carotid endarterectomy include those with symptomatic carotid artery stenosis (patients who have had a stroke or transient ischemic attack related to the stenosis) and those with asymptomatic carotid artery stenosis who have a high degree of stenosis (usually greater than 70%) and are otherwise healthy and have a good life expectancy. It is important to assess each patient individually to determine the most appropriate treatment option.

Timeline

Before carotid endarterectomy:

  1. Patient is diagnosed with carotid artery stenosis through imaging tests such as ultrasound or CT angiography.
  2. Patient may undergo medical management to control risk factors such as high blood pressure, high cholesterol, and smoking.
  3. Patient may be considered for carotid endarterectomy if the stenosis is severe and they are at high risk for stroke.
  4. Patient undergoes pre-operative evaluation and imaging tests to assess the severity of the stenosis and plan the surgery.

After carotid endarterectomy:

  1. Patient undergoes carotid endarterectomy surgery to remove plaque from the carotid artery.
  2. Patient is monitored closely in the hospital for any complications such as bleeding or stroke.
  3. Patient may require a short stay in the hospital for recovery.
  4. Patient is prescribed medications to prevent blood clots and manage risk factors for stroke.
  5. Patient is followed up with regular check-ups and imaging tests to monitor the status of the carotid artery and prevent future strokes.

What to Ask Your Doctor

Some questions a patient should ask their doctor about carotid endarterectomy include:

  1. What are the potential benefits of carotid endarterectomy for my condition?
  2. What are the potential risks and complications of carotid endarterectomy?
  3. How long is the recovery time after carotid endarterectomy?
  4. Will I need to take any medications or make any lifestyle changes after the procedure?
  5. How often will I need follow-up appointments or tests after carotid endarterectomy?
  6. Are there any alternative treatment options to consider?
  7. What is the success rate of carotid endarterectomy in reducing the risk of stroke?
  8. How experienced are you in performing carotid endarterectomy procedures?
  9. Can you provide me with any patient resources or information about carotid endarterectomy?
  10. Are there any specific factors in my medical history that may impact the effectiveness of carotid endarterectomy for me?

Reference

Authors: Reiff T, Eckstein HH, Mansmann U, Jansen O, Fraedrich G, Mudra H, Böckler D, Böhm M, Debus ES, Fiehler J, Mathias K, Ringelstein EB, Schmidli J, Stingele R, Zahn R, Zeller T, Niesen WD, Barlinn K, Binder A, Glahn J, Hacke W, Ringleb PA; SPACE-2 Investigators. Journal: Lancet Neurol. 2022 Oct;21(10):877-888. doi: 10.1016/S1474-4422(22)00290-3. PMID: 36115360