A Wayne State University School of Medicine researcher has published a clinical practice guideline in the journal Neurology stating that there is scientific evidence to support that carotid endarterectomy is useful in preventing future strokes. The guideline, which appears in the Sept. 27, 2005, issue of the scientific journal of the American Academy of Neurology, updates a 1990 statement on carotid endarterectomy.

Stroke affects more than 700,000 people in the United States per year. A blockage of a blood vessel is responsible for about 80 percent of strokes. Carotid endarterectomy is the most frequently performed operation to prevent stroke with about 150,000 to 200,000 procedures taking place each year.

"The evidence of this guideline points out an effective method of stroke prevention in certain people," said Seemant Chaturvedi, M.D., guideline author and director of the Wayne State University Stroke Program. "Carotid endarterectomy is beneficial for those with severe to moderate narrowing in their carotid artery."

Carotid endarterectomy is a surgical procedure that removes plaque and fatty deposits from blocking the carotid arteries which are the main suppliers of blood for the brain. There is strong evidence recommending carotid endarterectomy to prevent stroke in people who have severe (70 percent to 99 percent) blockage in their carotid artery. Nearly 25 percent of people who recover from their first stroke will have another stroke within five years. The guideline authors reviewed all of the scientific evidence on carotid endarterectomy.

The guideline found that carotid endarterectomy is effective for patients with severe stenosis (narrowing in a carotid artery) and recent symptoms of stroke or transient ischemic attack (TIA or mini-stroke). Carotid endarterectomy may also be considered for patients with moderate (50 percent to 69 percent) stenosis and recent symptoms of stroke.

For people between the ages of 40 and 75 with moderate to severe narrowing, but presenting with no symptoms of stroke or disease, carotid endarterectomy may be considered if the patient has at least a five-year life expectancy and if the surgery can be done with a low complication rate.

For patients with less than 50 percent stenosis, medical treatment is preferred over carotid endarterectomy.

People who undergo carotid endarterectomy should receive low-dose aspirin therapy (81 to 325 mg per day) prior to surgery and for at least three months following surgery, according to the guideline.

There is not enough evidence for or against having a carotid endarterectomy within four to six weeks of a moderate to severe stroke.

"We recommend further high-quality studies to evaluate the evidence/practice gap in the future," said Dr. Chaturvedi, an associate professor in the WSU Department of Neurology.

The guideline has been endorsed by the American Stroke Association and is available online at www.aan.com/professionals/practice/guideline/index.cfm.