Widespread screening or routine ultrasound for blocked neck arteries to determine stroke risk is not necessary, according to new guidelines from the American Heart Association/American Stroke Association, American College of Cardiology, American Association of Neurological Surgeons, and several other groups.
also state that carotid endarterectomy and carotid stenting are reasonable and effective ways to treat blocked neck arteries, though some patients may be a better candidate for one procedure over the other. When the carotid arteries on the side of the neck or vertebral arteries alongside the spinal column become clogged, less blood gets to the brain and the risk of stroke increases.
The writing committee, which included a wide range of specialists on stroke prevention, agreed there is not sufficient evidence of benefit for widespread screening. However, if a physicians hears abnormal blood flow when listening to a patient’s neck arteries, or if two or more risk factors are present, “then it is a reasonable approach,” said Jonathan L. Halperin, MD, professor of medicine at the Mount Sinai School of Medicine in New York, in a press release
“The guidelines will provide new information and evidence to help clinicians select treatment approaches with their patients,” said Thomas G. Brott, MD, professor of neurology and director of research at the Mayo Clinic campus in Jacksonville, FL.
Among dozens of recommendations, the writing group also noted that two often-competing procedures—carotid endarterectomy and stenting—are used to restore adequate blood flow to the brain past severely narrowed arteries. After reviewing the evidence, including two recent head-to-head comparisons, the writing committee concluded that both approaches are reasonable and safe when arteries are more than 50% blocked.
“The guidelines support carotid surgery as a tried-and-true treatment for most patients,” Brott said. “However, for patients who have a strong preference for less invasive treatments, carotid stenting offers a safe alternative. Because of the anatomy of their arteries or other individual considerations, some patients may be more appropriate for surgery and others for stenting.”
Furthermore, medications offer a better alternative than either surgery or stenting for many patients, according to the guidelines. In the latest clinical trials comparing the procedures, all patients received optimal medical treatment and there were no medication-only groups.
“The risks of these procedures have fallen considerably, but you need to make sure you have very experienced practitioners performing the latest techniques,” Halperin said.
The full text of the guidelines
will be published in Circulation: Journal of the American Heart Association, Stroke: Journal of the American Heart Association
, and Journal of the American College of Cardiology
The guidelines were developed with the American Association of Neuroscience Nurses; American Association of Neurological Surgeons; American Society of Neuroradiology; American College of Radiology; Congress of Neurological Surgeons; Society for Atherosclerosis Imaging and Prevention; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society for NeuroInterventional Surgery; Society for Vascular Medicine; and Society for Vascular Surgery.
The American Academy of Neurology and the Society of Cardiovascular Computed Tomography collaborated in the process.