Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: results of a systematic review and analysis

Stroke. 2009 Oct;40(10):e573-83. doi: 10.1161/STROKEAHA.109.556068. Epub 2009 Aug 20.


Significant advances in vascular disease medical intervention since large randomized trials for asymptomatic severe carotid stenosis were conducted (1983-2003) have prompted doubt over current expectations of a surgical benefit. In this systematic review and analysis of published data it was found that rates of ipsilateral and any-territory stroke (+/-TIA), with medical intervention alone, have fallen significantly since the mid-1980s, with recent estimates overlapping those of operated patients in randomized trials. However, current medical intervention alone was estimated at least 3 to 8 times more cost-effective. In conclusion, current vascular disease medical intervention alone is now best for stroke prevention associated with asymptomatic severe carotid stenosis given this new evidence, other cardiovascular benefits, and because high-risk patients who benefit from additional carotid surgery or angioplasty/stenting cannot be identified.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Angioplasty / adverse effects
  • Angioplasty / mortality
  • Angioplasty / statistics & numerical data
  • Anticholesteremic Agents / therapeutic use
  • Carotid Stenosis / drug therapy*
  • Carotid Stenosis / physiopathology
  • Carotid Stenosis / surgery
  • Cost-Benefit Analysis
  • Endarterectomy, Carotid / adverse effects
  • Endarterectomy, Carotid / mortality
  • Endarterectomy, Carotid / statistics & numerical data
  • Humans
  • Ischemic Attack, Transient / complications
  • Ischemic Attack, Transient / drug therapy*
  • Ischemic Attack, Transient / surgery
  • Risk Assessment
  • Stroke / drug therapy*
  • Stroke / prevention & control*
  • Stroke / surgery


  • Anticholesteremic Agents