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Stroke Prevention Treatment Varies Widely Across U.S.
Date:7/26/2010

By Steven Reinberg
HealthDay Reporter

MONDAY, July 26 (HealthDay News) -- Doctors across the United States differ greatly in how they choose to open up clogged neck arteries to help prevent stroke, a new study shows.

Carotid artery disease occurs when plaque fills up major arteries supplying blood to the brain, greatly raising stroke risk.

There are three common treatments for the condition: an artery-scraping surgery called endarterectomy; the placement of a stent to keep the artery open; or the use of cholesterol and antihypertensive medications to help lower stroke risk.

The new report finds that patients can expect to be offered different treatments depending on where in the United States they live -- a sign that there's no consensus on the best way to treat the condition, according to Duke University researchers.

There's a "clinical uncertainty about the best course of treatment," said lead researcher Lesley H. Curtis, an associate professor of medicine.

The report, funded by the U.S. Agency for Healthcare Research and Quality, is published in the July 26 issue of the Archives of Internal Medicine.

For the study, Curtis's team used Medicare data to find people 65 and older who underwent surgery or stenting from early 2003 through the end of 2006.

Over this period, the number of people undergoing artery-clearing endarterectomy surgery dropped from 3.2 per 1,000 patients a year to 2.6 per 1,000 patients per year. At the same time, the number of patients being stented rose, from 0.3 per 1,000 patients per year in 2005 to 0.4 per 1,000 patients per year in 2006, the researchers found.

However, "although overall rates of carotid revascularization [re-opening of the artery] have not changed as the use of carotid stents has grown, there remains significant variation in the use of carotid revascularization across communities in the U.S.," Curtis said.

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