Timely surgery can reduce risk of major stroke

March 20, 2004

Last Updated: 2004-03-19 16:20:34 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Surgery to clear blocked arteries that

supply blood to the brain is most beneficial in preventing a major

stroke if it is performed within two weeks after a minor stroke has

occurred, investigators report.

If this procedure, called carotid endarterectomy, is performed more than

two weeks after a patient has experienced a transient ischemic attack

(TIA) or nondisabling stroke, there may be no benefits at all.

" Ideally, the procedure should be done within two weeks of the patient's

last symptoms, " Dr. M. Rothwell at Radcliffe Infirmary in Oxford,

UK, and his colleagues advise in their report, published in The Lancet.

The authors pooled data from two large trials of carotid endarterectomy,

which included nearly 5900 patients recruited after a TIA, non-disabling

ischemic stroke or a blockage of the retina. Subjects were randomly

assigned to immediate endarterectomy or medical treatment.

For patients with at least 50-percent blockages, time from the last

minor stroke symptom to surgery was significantly associated with

effectiveness of the procedure. In fact, for patients with 50- to

69-percent blockages, only those treated within two weeks of the onset

of symptoms achieved clinical benefits, the authors note.

Endarterectomy " is often not done until several months after the

event--even if the patient seeks medical attention immediately after

their warning stroke, " Rothwell notes in a Lancet press release.

" Benefit from surgery is very much reduced at this time, and many

patients who would have benefited have their major stroke whilst waiting

for surgery. "

SOURCE: The Lancet, March 20, 2004.

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