Navigation Links
Researchers establish new rule to predict risk of stroke, death from surgery that prevents it
Date:12/10/2010

DALLAS Dec. 10, 2010 It's a medical Catch-22: carotid artery surgery can itself cause stroke, but so can asymptomatic carotid disease if left untreated.

UT Southwestern Medical Center researchers have now developed a clinical risk prediction rule using factors such as sex, race and health history to assess the danger the surgery poses, while a modified version will help patients make a more fully informed choice about whether to have the procedure.

"It may take a thief to catch a thief, but physicians don't want to cause stroke while trying to prevent stroke, so being able to carefully weigh an individual's benefits and risk from carotid surgery is critically important," said Dr. Ethan Halm, chief of the William T. and Gay Solomon Division of General Internal Medicine and senior author of the study published in the journal Stroke.

Researchers drew on factors that increase the risk for postsurgical death or stroke for people with silent, or asymptomatic, carotid disease to predict which patients were at highest risk for complications. Those most at risk were female, non-white and had certain neurologic and heart diseases.

The carotid arteries, which run on the sides of the neck, are main blood vessels that supply oxygen to the brain. These arteries can become narrowed by fatty cholesterol deposits called plaque. If pieces of plaque break free, they can lodge in the brain, causing stroke.

In carotid endarterectomy (CEA), one of the most common types of vascular surgery performed in the U.S., surgeons open the artery and remove the plaque. Silent, or symptom-free, carotid artery disease usually is found by chance during unrelated medical tests.

"Asymptomatic patients achieve only a modest benefit from surgery their chance of stroke decreases from 2 percent annually to 1 percent annually because they have a lower chance of having a stroke in the first place," Dr. Halm said. "For patients with several other medical risk factors, the upfront risk of surgery can outweigh any potential long-term benefits."

To create a predictive model to help determine a patient's risk, Dr. Halm and colleagues reviewed cases from the New York Carotid Artery Surgery study (NYCAS). The NYCAS evaluated outcomes of carotid surgeries performed on elderly patients in 167 hospitals in New York state between January 1998 and June 1999. Of the 9,308 surgeries, 6,553 were performed on asymptomatic patients. The average patient was 75 years old. Nearly 75 percent of patients had hypertension; 62 percent had coronary artery disease; and 29 percent had diabetes. Within 30 days of surgery, there were 55 deaths and 165 strokes.

The UT Southwestern researchers found that eight factors were independent predictors of death or stroke being female, a minority, or severely disabled, or having a history of stroke, having arteries narrowed more than 50 percent, coronary artery disease, congestive heart failure or valvular heart disease.

They assigned each risk factor one point, except for disability which counts as 2. Patients with a score of 0 to 2 are low risk; those with 3 points are at moderate risk; more than 4 are high risk. Using this CEA-8 rule, they determined that one-fourth of the NYCAS patients had a higher probability of death and stroke than the recommended national guidelines.

They then created the CEA-7, a patient-friendly model, that eliminates non-operative stenosis. Patients can also determine their own risk, even if they don't know whether their arteries are more than 50 percent blocked.

"These models are the first for asymptomatic patients and are a practical and easy-to-use tool for doctors and patients to evaluate what is best for them in the long term," Dr. Halm said. "These aren't the only factors a patient should consider individual health and experience of the surgeon and hospital team count, too but hopefully with these models, patients and doctors can more accurately individualize the risk of complications."

The authors are now developing an interactive educational program that helps patients better understand the different risks and benefits of surgical versus medical management of asymptomatic carotid disease.


'/>"/>

Contact: LaKisha Ladson
lakisha.ladson@utsouthwestern.edu
214-648-3404
UT Southwestern Medical Center
Source:Eurekalert

Related medicine news :

1. Researchers map all the fragile sites of the yeast Saccharomyces cerevisiaes genome
2. UH Case Medical Center researchers publish promising findings for advanced cervical cancer
3. Researchers discover new way to kill pediatric brain tumors
4. Researchers Who Discovered First Genes for Stuttering will Present Findings to the National Stuttering Association
5. Researchers create drug to keep tumor growth switched off
6. Urine protein test might help diagnose kidney damage from lupus, UT Southwestern researchers find
7. GUMC researchers say flower power may reduce resistance to breast cancer drug tamoxifen
8. Clemson researchers develop hands-free texting application
9. Researchers find biomarkers in saliva for detection of early-stage pancreatic cancer
10. Researchers chart genomic map spanning over 2 dozen cancers
11. Researchers discover second protective role for tumor-suppressor
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:5/26/2016)... ... 26, 2016 , ... There are many ways to cook a hot dog, ... that Americans prefer their dogs straight off the grill. Of the 90 percent of ... way to cook a hot dog, far outpacing other cooking methods such as steaming ...
(Date:5/26/2016)... ... May 26, 2016 , ... Cabot Corporation, ... defective respirators, according to court documents and SEC filings. A jury has ... Tyler v. American Optical Corporation, Case No. BC588866, Los Angeles County, California. The ...
(Date:5/26/2016)... ... May 26, 2016 , ... Georgia State ... its specialty academic programs. , Answering to the increasing demand for curricular specializations, ... health law, and environmental and land use law. ,  , “The demand for ...
(Date:5/26/2016)... ... May 26, 2016 , ... On Memorial Day, Hope For Heroes ... lives in military battle for the country. The nonprofit Hope For Heroes partnered ... programs that empower independence for disabled military veterans, as well as police, firemen, and ...
(Date:5/26/2016)... ... May 26, 2016 , ... Cardiac ... significant negative impact on long-term patient survival, reports a team of UPMC researchers ... this week in the Journal of Thoracic and Cardiovascular Surgery, provide critical information ...
Breaking Medicine News(10 mins):
(Date:5/25/2016)... Germany and GERMANTOWN, Maryland , ... QGEN ; Frankfurt Prime Standard: QIA) today announced ... agreement with Therawis Diagnostics GmbH to develop and commercialize predictive ... and market PITX2 as a marker to predict effectiveness of ... patients. "We are pleased to partner with Therawis, ...
(Date:5/25/2016)... , May 25, 2016 As ... Expo earlier this month, the numbers and momentum of ... to climb into the billions, more research and development ... 4th Edition State of Legal Marijuana Markets Report  from ... data-analysis firm, much of the increase in sector is ...
(Date:5/25/2016)... Inivata, a global clinical ... tumour DNA (ctDNA) analysis to improve personalised healthcare ... Clive Morris as Chief Medical Officer. ... development programme, scientific collaborations, and through to commercialisation ... in clinical outcomes for patients. Clive ...
Breaking Medicine Technology: