European analysis led by College Faculty London (UCL), along with Amsterdam UMC and the College of Basel exhibits {that a} vital proportion of sufferers who are suffering a stroke attributable to carotid artery narrowing might be handled with remedy solely. A dangerous carotid artery operation, at present nonetheless the usual therapy for a lot of sufferers, could then not be vital for this group of sufferers. This analysis, revealed in the present day within the Lancet Neurology, could result in the worldwide pointers for the therapy of those sufferers being adjusted.
Within the Netherlands, about 2,000 individuals with carotid artery stenosis are operated on yearly after they’ve had a stroke. 30 years in the past, massive research confirmed that an operation, through which a narrowing within the carotid artery is eliminated, diminished the danger of a brand new stroke. In consequence, this grew to become the worldwide standardised therapy. Since then, the drugs these sufferers obtain alongside their surgical procedure – comparable to blood thinners, remedy for ldl cholesterol and hypertension – have improved considerably. Researchers, together with Amsterdam UMC neurologist Paul Nederkoorn, investigated whether or not routine carotid artery operations are nonetheless vital in all sufferers. A global analysis group of neurologists, vascular surgeons, and radiologists collectively designed the ECST examine to reply this query.
“For the overwhelming majority of those sufferers, within the Netherlands maybe as much as about 75 %, remedy alone might be enough to cut back the danger of one other stroke. It’s a lot nicer for the affected person to not should have surgical procedure and it saves a number of healthcare prices,” says Nederkoorn. “We are actually going to work carefully with the vascular surgeons to see how we are able to greatest match these outcomes into the present protocols.”
Following sufferers for 2 years
Between 2012 and 2019, the researchers examined a gaggle of 429 sufferers, unfold over 30 facilities in Europe and Canada. All sufferers had a low or common probability of getting one other stroke inside 2 years of their preliminary therapy. Sufferers with a excessive danger of one other stroke weren’t included on this examine, as a result of it was unsure beforehand whether or not remedy alone may very well be equally efficient for them.
Sufferers had been divided into two teams. Half acquired solely remedy, and the opposite half additionally acquired normal surgical procedure. Two years after the beginning of their therapy, the sufferers had been monitored for a variety of outcomes. The teams had been in contrast on the premise of how usually new strokes had occurred, what number of sufferers had had a coronary heart assault and in what number of instances sufferers had had a stroke unnoticed or the place there was a excessive danger of a brand new stroke attributable to accumulations within the carotid artery. This may very well be seen on the MRI scans that the taking part sufferers acquired after 2 years. The 2 teams scored equally throughout all metrics, main the researchers to conclude that the operation just isn’t vital for this particular affected person group along with remedy.
Senior creator, Emeritus Professor at UCL Martin Brown, mentioned: “Whereas additional follow-up and extra trials are wanted to substantiate these findings, we suggest utilizing the CAR rating to determine sufferers with carotid narrowing who might be managed with optimised medical remedy alone.
“This strategy emphasises private evaluation and intensive therapy of vascular danger components, doubtlessly sparing many sufferers from the discomfort and dangers of carotid surgical procedure or stenting.
“Moreover, this methodology may result in substantial price financial savings for well being companies.”
Adjusting worldwide pointers
Comply with-up analysis ought to present which sufferers have such a excessive danger of one other stroke that they nonetheless do want surgical procedure along with the remedy. New methods for detailed imaging of the atherosclerotic plaque within the carotid artery enable for the collection of significantly high-risk sufferers rather more precisely than earlier than. The researchers assume that sooner or later this would be the group that will nonetheless should bear surgical procedure. On this method, each affected person with a stroke attributable to carotid artery narrowing can obtain a tailored risk-based therapy. That saves many sufferers a serious operation and lowers healthcare prices. The researchers anticipate that the nationwide and worldwide pointers will quickly be adjusted. “At Amsterdam UMC, we’re working along with the vascular surgeons and people low- and medium-risk sufferers are not operated on as normal,” concludes Nederkoorn
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Journal reference:
Donners, S. J. A., van Velzen, T. J., Cheng, S. F., Gregson, J., Hazewinkel, A.-D., Pizzini, F. B., Emmer, B. J., Simister, R., Richards, T., Lyrer, P. A., Maurer, M., Smith, G., Tervit, G., van der Steen, L., Pickett, G. E., Gubitz, G., Roozenbeek, B., Scheele, M., Bamford, J. M., & Kooi, M. E. (2025). Optimised medical remedy alone versus optimised medical remedy plus revascularisation for asymptomatic or low-to-intermediate danger symptomatic carotid stenosis (ECST-2): 2-year interim outcomes of a multicentre randomised trial. The Lancet Neurology, 24(5), 389–399. https://doi.org/10.1016/S1474-4422(25)00107-3