Rethinking stroke prevention for patients with mild carotid narrowing

 I would never do a carotid endarterectomy with all its' risks. I'm still of the opinion that you determine if the Circle of Willis is complete then you just close up the artery. I'm not medically trained so that opinion is obviously not worth listening to. 

Here is why your doctor needs to guarantee NO complications from endarterectomy!

Talk to your doctor about the dangers of stroke due to the endarterectomy procedure and why you would want to put inflexible metal stents in flexible arteries.

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021) 

The latest here:

Rethinking stroke prevention for patients with mild carotid narrowing 

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University of ToyamaApr 24 2025

Ischemic stroke remains one of the leading causes of death and long-term disability worldwide, with narrowing of the carotid artery due to atherosclerosis contributing to up to 30% of all cases. For decades, medical practitioners have primarily relied on the degree of carotid narrowing (stenosis) to assess the risk of stroke and determine the best treatment options. However, mounting evidence suggests that this approach may be insufficient for patients with mild but symptomatic carotid stenosis.

Despite being classified as 'low-risk' due to having less than 50% carotid artery narrowing, a significant number of patients with mild carotid stenosis continue to experience recurrent ischemic events, even when receiving appropriate medical therapy. This implies that factors beyond the degree of stenosis may play a crucial role in determining stroke risk for this patient population.

To address this gap, a team including Lecturer Daina Kashiwazaki and Dr. Satoshi Kuroda from Toyama University, Japan, aimed to tackle this knowledge gap via their 'Mild but Unstable Stenosis of Internal Carotid Artery (MUSIC)' study. This multicenter prospective cohort study, which was published online on February 21, 2025, in the Journal of Neurosurgery, investigated the clinical features, radiological findings, and treatment outcomes of patients with symptomatic mild carotid stenosis.

The researchers enrolled 124 patients who had experienced cerebrovascular or retinal ischemic events ipsilateral (same side) to mild carotid stenosis. While all participants received the best medical therapy (BMT) for their condition, carotid endarterectomy (CEA)-the surgical removal of plaque-or carotid artery stenting (CAS) was performed in 63 patients. Patients were followed up for two years, with the primary endpoint being the occurrence of ipsilateral ischemic stroke.

The findings were quite striking: approximately 81% of patients had radiologically unstable plaque, with 59.5% exhibiting intraplaque hemorrhage (IPH). This type of plaque composition was associated with a significantly higher risk of both primary and secondary endpoints, the latter of which included ocular symptoms, any type of stroke, and plaque progression requiring CEA. Additionally, the incidence of ipsilateral ischemic stroke was markedly higher in the group receiving only BMT compared to those who also underwent CEA (15.1% vs. 1.7%). "The distinctive clinical and radiological features in high-risk patients strongly indicate that plaque composition, namely IPH, but not degree of stenosis, plays a key role in subsequent ischemic events in patients with symptomatic mild carotid stenosis," explains Kashiwazaki.