New Data Presented at VAM26 Explores How Carotid Endarterectomy and Carotid Artery Stenting Compare in Real-World Patient Populations

 I can't ever see doing carotid stenting or endarterectomy with all the risks of those procedures. Your doctor NEEDS TO GUARANTEE NO PROBLEMS IF DONE OR THE MEDICAL LICENSE IS LOST! 

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Here is why your doctor needs to GUARANTEE NO complications from stenting!

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021)

 The obvious solution is check if the Circle of Willis is complete, then close up the offending artery!

My right carotid artery was at 80% blockage at time of stroke and then thankfully fully closed up 3 years later. Remained closed for 10 years and I cognitively functioned quite well with no episodes of fainting or poor executive functioning. Eventually collaterals grew around the blockage. Since my Circle of Willis is complete, I still had 3 fully functioning arteries supplying blood to the brain, obviously enough to keep me highly functioning. I'm glad that my doctors were so incompetent they never found that 80% blockage, otherwise they probably would have insisted I undergo either stenting or endarterectomy, both of which they couldn't guarantee no problems. And I didn't find out about those problems until years later researching for this blog.

The latest here:

New Data Presented at VAM26 Explores How Carotid Endarterectomy and Carotid Artery Stenting Compare in Real-World Patient Populations

Study Finds Long-Term Stroke and Death Rates Favor Carotid Endarterectomy (CEA) over Carotid Artery Stenting (CAS) in Treating Patients with Asymptomatic Carotid Artery Stenosis 

BOSTON, MA, JUNE 13, 2026 – Today, the Society for Vascular Surgery (SVS) announced the findings of a new study demonstrating the safety and efficacy of emerging treatment options for patients with asymptomatic carotid stenosis (ACS).

Carotid stenosis occurs when plaque builds up in the carotid artery, narrowing the vessel and restricting blood flow to the brain and can lead to stroke. However, ACS occurs when the artery is narrowed by at least 70-80% without a recent stroke, significantly increasing the risk of future stroke, cardiovascular events, and cognitive decline. It is estimated that two million North Americans and Europeans live with treatable asymptomatic carotid artery stenosis (NIH).

In November 2025, the New England Journal of Medicine published data from the Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Study (CREST-2), focused on revascularization practices to manage stroke risk in ACS patients. SVS published an opinion piece on why CREST-2 trial results should inform, not replace, clinical judgement due to how the trial reflects idealized medical therapy, not routine clinical practice. 

“Data presented at the Society for Vascular Surgery’s Vascular Annual Meeting underscores the importance of knowledge of which intervention, if any, is optimal for stroke management in patients with carotid disease,” said Keith D. Calligaro, MD, Chief, Vascular Surgery at Pennsylvania Hospital, President, Society for Vascular Surgery. “We should not disregard the findings of many past studies showing the benefit of carotid endarterectomy over carotid stenting in selected patients. The findings highlight the need for randomized clinical trials, real-world outcomes data, and the expertise of vascular surgeons, the only specialty that can perform trans-femoral carotid stenting, TCAR and CEA.”

Carotid Stenosis Patients Experience Improved Stroke and Mortality Outcomes Three Years After CEA than CAS

Using the TriNetX Collaborative US Network, a multi-institutional electronic health record platform continuously updating real-world data from healthcare organizations, researchers aim to compare perioperative and long-term outcomes of CEA and CAS in asymptomatic patients. Researchers selected adult patients with ACS who underwent CEA or CAS from the TriNetX Network. Patients were matched 1:1 using a propensity score match (PSM) to balance baseline characteristics like demographics, comorbidities, and relevant medications. The study’s primary outcomes included stroke, death, and the composite outcome of stroke or death at 30 days, one year, three years, and five years.

The study identified 101,714 patients in total, 61,124 of whom underwent CEA (60.1%) and 40,590 CAS (39.9%). Through PSM, 39,471 patients were matched to each cohort with balanced baseline characteristics. The CEA group showed consistently lower rates of stroke at 30 days (2.0% vs 2.4%, p=0.001), one year (2.9% vs 3.3%, p=0.001), three years (3.6% vs 3.9%, p=0.008), and five years (4.1% vs 4.4%, p=0.038). This group also saw significantly lower mortality rates at three years (11.8% vs 12.4%, p=0.014),though other time points reflected similar rates. At every time period stroke or death outcomes favored the CEA group, with significant differences observed at 30 days (3.9% vs 4.2%, p=0.049), one year (8.7% vs 9.4%, p=0.001), three years (14.9% vs 15.8%, p< 0.001), and five years (20.1% vs 20.8%, p=0.013).

“Our results suggest that CEA has more favorable stroke and mortality outcomes when patient demographics are equal,” said lead author Anthony H. Chau, MD, Associate Professor of Vascular and Endovascular Surgery, University of California, Irvine. “However, our findings do not conclude that every patient should undergo CEA. Instead, they remind us how paramount patient selection is when treating carotid artery stenosis, and the detail that should go into selecting the right procedure for the right patient.”

Session Details:

• “Carotid endarterectomy has improved long-term stroke and survival compared to carotid artery stenting in a real-world propensity-matched cohort analysis using the TriNetX Network”
  • Saturday, June 13th from 9:04 am – 9:11 am ET (Plenary 7)

### 

About the Society for Vascular Surgery
The Society for Vascular Surgery® (SVS) seeks to advance excellence and innovation in vascular health through education, advocacy, research, and public awareness. The organization was founded in 1946 and currently has a membership of approximately 6,500. SVS membership is recognized in the vascular community as a mark of professional achievement. For more information, visit Vascular.org.

About VAM26
The Society for Vascular Surgery’s Vascular Annual Meeting (VAM) will be held in Boston, MA, on June 10-13. Leading physicians, researchers, and health care professionals in vascular surgery gather for three full days of groundbreaking educational content showcasing the latest data, research, and innovations in vascular surgery and vascular health. For more information, visit vam.vascular.org.

Press Contact:

Bethany Grassley

bgrassley@brgcommunications.com

703-739-834

Non‑O blood type is linked to higher post‑CAS stroke and TIA risk

 I can't ever see doing carotid stenting or endarterectomy with all the risks of those procedures. Your doctor NEEDS TO GUARANTEE NO PROBLEMS IF DONE OR THE MEDICAL LICENSE IS LOST! 

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Here is why your doctor needs to GUARANTEE NO complications from stenting!

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021)

 The obvious solution is check if the Circle of Willis is complete, then close up the offending artery!

My right carotid artery was at 80% blockage at time of stroke and then thankfully fully closed up 3 years later. Remained closed for 10 years and I cognitively functioned quite well with no episodes of fainting or poor executive functioning. Eventually collaterals grew around the blockage. Since my Circle of Willis is complete, I still had 3 fully functioning arteries supplying blood to the brain, obviously enough to keep me highly functioning. I'm glad that my doctors were so incompetent they never found that 80% blockage, otherwise they probably would have insisted I undergo either stenting or endarterectomy, both of which they couldn't guarantee no problems. And I didn't find out about those problems until years later researching for this blog.

The latest here:

Non‑O blood type is linked to higher post‑CAS stroke and TIA risk

BACKGROUND

Carotid angioplasty and stenting (CAS) has increasingly been used as an alternative to carotid endarterectomy (CEA) in the treatment of carotid artery disease. However, neurological complications following carotid angiography or CAS remain a clinical concern. This study aimed to evaluate whether naturally occurring ABO blood group antigens and hematological parameters are associated with cerebrovascular complications after diagnostic or therapeutic carotid angiography.

METHODS

In this single-center retrospective study, patients were classified as blood group O or non-O (A, B, or AB). Cerebrovascular complications were defined as in-hospital amaurosis fugax, transient ischemic attack (TIA), or stroke occurring after carotid angiography or carotid artery stenting (CAS).

RESULTS

A total of 316 patients who underwent carotid angiography were included; 106 (33.5%) had blood group O and 210 (66.5%) had non-O blood groups. Cerebrovascular events were significantly more frequent in patients with non-O blood groups. Stroke occurred in 13.8% of patients with non-O blood groups compared with 1.9% in those with blood group O (p < 0.001), while TIA was also more common in the non-O group (11.0% vs. 3.8%, p = 0.033). When stratified by procedure type, this association was predominantly observed in patients undergoing CAS, whereas cerebrovascular event rates were low and comparable between groups in patients undergoing diagnostic angiography alone. In univariable analysis, diabetes mellitus was associated with stroke (OR = 2.392, p = 0.024), while blood group O was associated with lower odds of stroke (OR = 0.120, p = 0.004). In multivariable analysis, blood group O (OR = 0.127, p = 0.007) and contrast volume (OR per 10 mL increase: 1.218, p < 0.001) remained independently associated with stroke, whereas diabetes mellitus was no longer statistically significant.

CONCLUSION

Non-O blood groups were associated with a higher risk of stroke and TIA following carotid angiography, particularly in patients undergoing CAS, whereas blood group O was associated with a lower risk of stroke. These findings should be interpreted with caution due to the observational design and potential residual confounding.

REFERENCES

1. ABO blood group and cerebrovascular complications after carotid angiography and stenting: a natural thrombotic marker?

   Evsen A, Altunova M.

   J Clin Neurosci. 2026 Jun 7; 152 112128 [Epub ahead of print]

Cognitive Impairment Risk Increases With Carotid Stenosis Severity

My right carotid artery was at 80% blockage at time of stroke and then thankfully fully closed up 3 years later. Remained closed for 10 years and I cognitively functioned quite well with no episodes of fainting or poor executive functioning. Eventually collaterals grew around the blockage. Since my Circle of Willis is complete, I still had 3 fully functioning arteries supplying blood to the brain, obviously enough to keep me highly functioning. I'm glad that my doctors were so incompetent they never found that 80% blockage, otherwise they probably would have insisted I undergo either stenting or endarterectomy, both of which they couldn't guarantee no problems. And I didn't find out about those problems until years later researching for this blog.

Cognitive Impairment Risk Increases With Carotid Stenosis Severity

 Increased severity of carotid stenosis is significantly associated with poorer executive function and slower processing speed, independent of traditional vascular risk factors and history of stroke. Patients with greater carotid stenosis demonstrate significantly worse processing speed and executive function performance compared with those who have less severe disease, according to results of a study published in Alzheimer’s & DementiaAsymptomatic extracranial carotid atherosclerotic disease (aECAD) has been associated with a 22% increased risk for Alzheimer disease, but previous studies evaluating the effect of aECAD on cognitive outcomes have been limited by methodological biases.To better characterize early cognitive changes associated with aECAD, researchers from the University of Arizona examined data from the Carotid and Mind (CAM) clinical study. The researchers evaluated data from the first 182 individuals enrolled in CAM between 2022 and 2024, of whom 167 were included in the final analysis. Participants were aged 50 to 85 years and were recruited from vascular surgery and cardiology clinics. All participants underwent magnetic resonance imaging (MRI), carotid stenosis assessment using North American Symptomatic Carotid Endarterectomy Trial criteria, and comprehensive neurocognitive testing. The researchers defined aECAD as greater than 50% carotid stenosis without a history of stroke or transient ischemic attack in the previous 6 months. This work builds momentum for clinical management changes and future studies with a long-term goal of dementia prevention.

The study population had a mean (SD) age of 72 (7) years, 57% were men, 96% were White, 49% had 13 to 16 years of education, 36% had less than 50% carotid stenosis, and 26% carried the apolipoprotein E (APOE) ε4 allele.

After adjusting for age, sex, race, and ethnicity, increasing carotid stenosis severity was significantly associated with slower processing speed (adjusted b [ab], -0.20; 95% CI, -0.34 to -0.07; P =.004) and poorer executive function (ab, -0.19; 95% CI, -0.33 to -0.05; P =.009).

At the individual test level, greater carotid stenosis was associated with worse performance on the Wechsler Adult Intelligence Scale (ab, -0.26; 95% CI, -0.40 to -0.12; P <.001), Stroop Color-Word Interference (ab, -0.21; 95% CI, -0.35 to -0.07; P =.003), and Trail Making Test part A (ab, -0.21; 95% CI, -0.36 to -0.06; P =.007). Using these 3 tests, a composite Carotid Cognitive Index (CCI) was formulated.

The CCI was also inversely related with phosphorylated tau217 (p-tau217; r, -0.33; P <.001). This relationship was independent of white matter lesion volume (ab, -0.27; P =.006); demographic factors of age, gender, race, ethnicity, and education (ab, -0.24; P =.005); vascular risk factors (ab, -0.22; P =.01); APOE ε4 status (ab, -0.21; P =.01); and vascular disease history (ab, -0.21; P =.02). Higher p-tau217 levels were independently associated with APOE ε4 carriership (b, 0.57; P <.001).

Study limitations include a lack of racial and ethnic diversity.

The study authors concluded, “Although patients with carotid disease are not regularly evaluated clinically for cognitive impairment or dementia, this work builds momentum for clinical management changes and future studies with a long-term goal of dementia prevention.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Asymptomatic Blocked Carotids Don't Need Surgery, Large Trial Shows

 

Why would you want to do stenting or endarterectomy at all if your doctor won't guarantee no problems?

I still don't understand why you would medically need to stent a carotid artery or do an endarterectomy at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.

Didn't your competent? doctor tell you of these possible complications of endarterectomy? NO? So, your doctor isn't competent?

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Here is why your doctor needs to GUARANTEE NO complications from stenting!

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021)

The latest here:

Asymptomatic Blocked Carotids Don't Need Surgery, Large Trial Shows

Stenting high-grade carotid stenosis did help prevent stroke or death, but experts question worth

Key Takeaways

• Most carotid-artery stenting or endarterectomy is done for asymptomatic cases.
• The large CREST-2 randomized trial now shows that endarterectomy holds no stroke and mortality benefit over intensive medical management alone.
• Stenting did provide a stroke or death prevention benefit over 4 years compared with medical treatment alone but the absolute difference in rates was small and experts suggested reserving this option for symptomatic patients.

For asymptomatic carotid stenosis, stenting helped prevent strokes compared with modern medical treatment whereas endarterectomy did not in the CREST-2 randomized trials.

The primary composite endpoint of any stroke or death at 44 days or ipsilateral ischemic stroke out to 4 years of follow-up occurred in 2.8% of patients randomly assigned to carotid stenting versus 6.0% in those on medical therapy alone (P=0.02), reported James F. Meschia, MD, of the Mayo Clinic in Jacksonville, Florida, and colleagues in the New England Journal of Medicine.

That rate was 3.7% with endarterectomy compared with 5.3% on medical therapy, a difference which didn't meet statistical significance (P=0.24).

"We can conclude that there is no longer a role for routine carotid endarterectomy in persons with asymptomatic stenosis," concluded an accompanying editorial by Martin M. Brown, FRCP, of University College London, and Leo H. Bonati, MD, of Basel University in Switzerland.

Some 75-80% of carotid-artery stenting or endarterectomy recipients in the U.S. are asymptomatic, although management has been controversial.

"Decades ago, surgery clearly helped prevent strokes in many patients," co-author Thomas Brott, MD, also of the Mayo Clinic in Jacksonville, noted in a statement. "But medical therapy has improved so much that we needed to reexamine the balance between benefit and risk for people who have no symptoms."

Along with the previous CREST trial that showed in 2010 that the two procedures had similar short- and longer-term outcomes in symptomatic and asymptomatic individuals at average surgical risk (albeit with more periprocedural strokes in the stenting group), the Second Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE-2) trial had similar results. The recent but smaller Second European Carotid Surgery Trial (ECST-2) also showed no advantage to revascularization over medical management alone.

But despite statistical significance favoring stenting in CREST-2, the editorialists cautioned against widespread adoption for asymptomatic but high-grade (≥70%) stenosis like that in the trial.

"The benefit from revascularization of asymptomatic carotid stenosis with regard to stroke prevention has become small with improved medical therapy," they wrote, calculating that the event rates meant 95 of every 100 patients would have had an unnecessary procedure over a 4-year period.

Also, the trial reflected a best-case scenario for the procedure, with careful selection of patients and skilled interventionists that would not be available in all vascular centers, Brown and Bonati noted. Medical therapy wasn't perfect either, with only 60-70% of the patients achieving a systolic blood pressure under 130 mm Hg, less than 80% getting LDL cholesterol within the 70 mg/dL target, and only about half of diabetes patients reaching HbA1c goals.

Since two-thirds of the events in patients treated with medical therapy alone were nondisabling strokes that would be expected to lead to good or fair recovery and put them in line for secondary prevention carotid revascularization, the editorialists suggested a pragmatic strategy: "We therefore consider it reasonable to advise patients with asymptomatic carotid stenosis to start intensive medical therapy immediately and to delay revascularization until such time as symptoms develop, which will occur in only a small proportion of patients. Exceptions would then be made for patients who prefer to take the risk of revascularization or who cannot take medical therapy -- in which case, stenting would be the choice for suitable patients at a center with skilled and experienced interventionists."

CREST-2 comprised two parallel trials in patients with at least 70% asymptomatic carotid stenosis seen at 155 centers in five countries. One trial randomly assigned 1,245 adults to receive either intensive medical management alone or with carotid-artery stenting. The other trial randomized 1,240 patients to intensive medical management alone or with endarterectomy.

Serious complications were uncommon with either procedure.

One limitation was the trials' single-blind design in which patients and treating physicians were aware of treatment group assignment; another was that the trial predated the new lower systolic blood pressure guidelines, the advent of PCSK9 inhibitors, and widespread dissemination of new, highly effective diabetes and obesity medication. Transcarotid-artery revascularization, while now in frequent use, wasn't incorporated in the trial.

Importantly, "the difference between stenting and medical management was based on a small number of events," the editorialists noted, such that the primary endpoint was fragile. Only three more events in the stenting group would have tipped the trial to a neutral finding.

Brott suggested that personalized decision making should play a key role, with stenting being more appealing particularly for patients with higher-grade stenosis or plaque that appears unstable or more likely to cause a blockage.

"What we need now are trials focusing on identification of the small proportion of patients with carotid stenosis in whom symptoms develop despite the use of medical therapy," the editorialists wrote, concurring with Meschia's group. "The most promising approach uses magnetic resonance imaging of carotid-artery plaque to identify intraplaque hemorrhage, a strong risk factor for stroke."

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 

• Download PDF Copy

 Reviewed

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.

Data-driven tool helps direct decision-making for stroke patients

 Wow! The starting location of the clot has little bearing on the damage done, so this started with an incorrect basis! What is really needed is an EXACT 3D RENDERING of both white and gray matter(eg. Objective damage diagnosis) 

Data-driven tool helps direct decision-making for stroke patients

Researchers at Ochsner Health have developed a tool that can help guide treatment choices after a patient’s carotid stroke.

By

Andis Robeznieks , Senior News Writer

Apr 23, 2025 | 6 Min Read

Health System Spotlight

Subscribe

AMA News Wire

Data-driven tool helps direct decision-making for stroke patients

Apr 22, 2025

Using eight years of data and blending the findings from three previous studies, physicians and researchers from Ochsner Health in New Orleans developed a predictive tool that helps inform medical decisions for patients who experience carotid stroke.

AMA Health System Program

Providing enterprise solutions to equip your leadership, physicians and care teams with resources to advance your programs while being recognized as a leader. 

Join Us

“Our goal is to precisely identify which patients presenting with a carotid-related stroke will benefit most from urgent intervention, minimizing risk and optimizing clinical outcomes through personalized, data-driven decisions,” said Hernan Bazan, MD, professor of surgery and cardiovascular innovation at Ochsner Health.

By examining four clinical factors—stroke severity, time to intervention, thrombolysis use and frailty risk(Time is the only objective measurement, so your model is almost totally fucking useless)—Ochsner Health physicians can now predict “functional neurologic independence” with 93% accuracy in patients undergoing urgent carotid interventions for acute stroke, according to a study published in the Journal of the American College of Surgeons (JACS).(Do you not understand, recovery prediction is useless for stroke survivors? It does nothing to get them recovered.)

“This advanced predictive model significantly improves clinical decision-making by accurately identifying patients most likely to benefit from timely carotid revascularization, ultimately enhancing patient outcomes and resource utilization,” Dr. Bazan said.

Ochsner Health is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine. 

“Prehab” benefits frail patients

Stroke is the fifth-leading cause of death in the U.S., and carotid artery disease accounts for up to 20% of all ischemic strokes. For stroke patients, carotid endarterectomy and carotid artery stenting are widely used interventions to prevent more “ischemic events,” the JACS study says.(I would never do either, way too much risk!

I still don't understand why you would medically need to treat a carotid artery at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.

Before you go down either route ask your doctor to GUARANTEE NO STROKE from either procedure. If it was me I would ask my doctor to see if the Circle of Willis was complete; if yes, then have the doctor close up the offending artery. My right carotid artery completely closed up for 14 years before collaterals grew around it. I have had no dizziness or cognitive issues with only 3 arteries feeding the Circle of Willis.

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

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)

While some stroke patients may benefit from immediate surgery, Dr. Bazan said most should wait at least 48 hours, while others may need to undergo “prehab” before surgery to gain strength and improve their chances for a positive outcome.

“Timing is critical—some patients benefit from immediate intervention, but most see better outcomes when surgery is deferred for at least 48 hours,” Dr. Bazan explained. “For frailer, higher-risk patients, targeted pre-habilitation may further optimize their chances for success.”

Hernan Bazan, MD

Guidelines recommend revascularization within 14 days of symptom onset for neurologically stable patients. But, with the establishment of regional stroke centers, “urgent” carotid interventions are increasingly performed during the initial hospitalization after an acute ischemic stroke. 

Accurately predicting neurological functional outcomes in this high-risk group remains a significant clinical challenge, according to Dr. Bazan.

“Early intervention carries risks such as hemorrhage, making patient-specific timing crucial for safety and effectiveness,” Dr. Bazan noted. “As comprehensive stroke centers see growing numbers of these complex cases, clinically validated predictive tools will become essential in the future to enhancing decision-making and patient outcomes.”

Dr. Bazan and colleagues presented their findings on the importance of evaluating patient frailty in medical decision-making for stroke patients in an another study published by the Journal of Vascular Surgery in December 2024.

They used the Hospital Frailty Risk Score that is based on International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes and created stroke-specific risk categories based on the incidence of stroke, death and myocardial infarction.

The stroke patient-frailty calculator allows immediate evaluation of the patient’s condition.

“Integrating real-time frailty assessment into clinical decision-making addresses a significant unmet need, helping clinicians precisely determine which patients should undergo immediate intervention and who would benefit from prehabilitation,” explained Dr. Bazan.

“The strategic advantage is that the frailty-risk score is seamlessly integrated into our EMR system, making it instantly accessible and actionable at the point of care,” Dr. Bazan emphasized. “My clinical team actively uses it during daily rounds.”

From AI implementation to EHR adoption and usability, the AMA is fighting to make technology work for physicians, ensuring that it is an asset to doctors—not a burden.

Subscribe to learn how innovative health systems reduce physician burnout.

Subscribe Now

Seeking functional independence

The first research paper by Dr. Bazan’s team looked at stroke severity and the use of tissue plasminogen activator (tPA), a thrombolysis—or blood-clot dissolving—drug. While patients with high stroke severity had worse functional outcomes, those with minor or moderate strokes were more likely to be discharged with neurological functional independence whether or not they received tPA.

Stroke severity “is predictive of discharge neurological functional autonomy and is not influenced by the use of thrombolysis,” the researchers concluded in a September 2023 study published in the Journal of Vascular Surgery.

Last June, Dr. Bazan and Ochsner biostatisticians Daniel Fort, PhD, and Jeffrey Burton, PhD, began tying together the studies, which included presenting clinical factors and neurological outcomes data from 302 patients who had emergency carotid endarterectomy or carotid artery stenting at Ochsner Health between 2015 to 2023.

“What I posited to them was: Look, we have so much data now with stroke where we looked at these things individually—stroke severity, thrombolysis use, time to intervention, frailty risk—what if we build a model where we make them interact and how predictive would that model be?” Dr. Bazan recalled.

“So we took all four things in a concerted fashion, and we made them interact,” he added.

The model they produced achieved 93% accuracy as to where patients would score on the neurologic modified ranking scale. The scale ranges from zero to six, with zero to two denoting a patient’s ability to maintain independent living without a caregiver.

Dr. Bazan noted that using this predictive tool aligns with the Centers for Medicare & Medicaid Services’ (CMS) initiative for age-friendly hospital inpatient care that seeks to address challenges seen in the delivery of complex care to older adults with multiple chronic conditions and is described in the 2025 Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals payment schedule.

The initiative is organized around “4 M” elements: What Matters, Medication, Mentation or mental activity, and Mobility.

“Our goal is to enhance clinical utility by precisely tailoring stroke care decisions to each patient’s unique risk profile,” Dr. Bazan explained. “The timing is ideal, aligning closely with the 2025 CMS initiatives that emphasize value-based care and age-friendly health care measures.”

Plans to incorporate AI

The model was developed by the human mind and not augmented intelligence (AI), often referred to as “artificial intelligence.”

“This is strictly mathematics,” Dr. Bazan said. “It’s a lot of mathematics done by our senior author Jeff Burton.”

There are, however, plans to integrate augmented intelligence (AI)-powered diagnostic imaging into the model.

“We're going to use imaging and AI to read in an automated way how big the stroke infarct is and add that to the four factors,” Dr. Bazen explained. “That's the future—incorporating the anatomical stroke volume and then it will be even more patient specific.”

The predictive tool does not dismiss and cannot act as a substitute for a physician’s clinical acumen, because—like most aspects of medicine—there are no binary, “yes or no” answers, Dr. Bazan noted.

“This tool does not replace clinical judgment derived from experience; rather, it provides validated, real-time risk stratification to support and enhance individualized decision-making,” he explained.

Many stroke patients with carotid artery narrowing may avoid surgery, research shows

 

 I still don't understand why you would medically need to stent a carotid artery or do an endarterectomy at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.

Didn't your competent? doctor tell you of these possible complications of endarterectomy? NO? So, your doctor isn't competent?

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Here is why your doctor needs to GUARANTEE NO complications from stenting!

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021)

Many stroke patients with carotid artery narrowing may avoid surgery, research shows

• Download PDF Copy

 Reviewed

Amsterdam University Medical CenterApr 16 2025

European research led by University College London (UCL), together with Amsterdam UMC and the University of Basel shows that a significant proportion of patients who suffer a stroke due to carotid artery narrowing can be treated with medication only. A risky carotid artery operation, currently still the standard treatment for many patients, may then no longer be necessary for this group of patients. This research, published today in the Lancet Neurology, may lead to the global guidelines for the treatment of these patients being adjusted.

In the Netherlands, about 2,000 people with carotid artery stenosis are operated on every year after they have had a stroke. 30 years ago, large studies showed that an operation, in which a narrowing in the carotid artery is removed, reduced the risk of a new stroke. As a result, this became the international standardised treatment. Since then, the medications these patients receive alongside their surgery – such as blood thinners, medication for cholesterol and high blood pressure – have improved significantly. Researchers, including Amsterdam UMC neurologist Paul Nederkoorn, investigated whether routine carotid artery operations are still necessary in all patients. An international research group of neurologists, vascular surgeons, and radiologists together designed the ECST study to answer this question.

For the vast majority of these patients, in the Netherlands perhaps up to about 75 percent, medication alone is probably sufficient to reduce the risk of another stroke. It is a lot nicer for the patient not to have to have surgery and it saves a lot of healthcare costs. We are now going to work closely with the vascular surgeons to see how we can best fit these results into the current protocols."

Paul Nederkoorn, Amsterdam UMC neurologist

Following patients for two years

Between 2012 and 2019, the researchers examined a group of 429 patients, spread over 30 centers in Europe and Canada. All patients had a low or average chance of having another stroke within 2 years of their initial treatment. Patients with a high risk of another stroke were not included in this study, because it was uncertain beforehand whether medication alone could be equally effective for them.

Patients were divided into two groups. Half received only medication, and the other half also received standard surgery. Two years after the start of their treatment, the patients were monitored for a number of outcomes. The groups were compared on the basis of how often new strokes had occurred, how many patients had had a heart attack and in how many cases patients had had a stroke unnoticed or where there was a high risk of a new stroke due to accumulations in the carotid artery. This could be seen on the MRI scans that the participating patients received after 2 years. The two groups scored equally across all metrics, leading the researchers to conclude that the operation is not necessary for this specific patient group in addition to medication.

Senior author, Emeritus Professor at UCL Martin Brown, said: "While further follow-up and additional trials are needed to confirm these findings, we recommend using the CAR score to identify patients with carotid narrowing who can be managed with optimised medical therapy alone.

Biotechnology eBook Compilation of the top interviews, articles, and news in the last year. Download the latest edition

"This approach emphasises personal assessment and intensive treatment of vascular risk factors, potentially sparing many patients from the discomfort and risks of carotid surgery or stenting.

"Additionally, this method could lead to substantial cost savings for health services."

Adjusting international guidelines

Follow-up research should show which patients have such a high risk of another stroke that they still do need surgery in addition to the medication. New techniques for detailed imaging of the atherosclerotic plaque in the carotid artery allow for the selection of particularly high-risk patients much more accurately than before. The researchers think that in the future this will be the group that may still have to undergo surgery. In this way, every patient with a stroke due to carotid artery narrowing can receive a tailor-made risk-based treatment. That saves many patients a major operation and lowers healthcare costs. The researchers expect that the national and international guidelines will soon be adjusted.

"At Amsterdam UMC, we are working together with the vascular surgeons and those low- and medium-risk patients are no longer operated on as standard," concludes Nederkoorn

Source:

Amsterdam University Medical Center

Journal reference:

Donners, S. J. A., et al. (2025). Optimised medical therapy alone versus optimised medical therapy plus revascularisation for asymptomatic or low-to-intermediate risk symptomatic carotid stenosis (ECST-2): 2-year interim results of a multicentre randomised trial. The Lancet Neurology. doi.org/10.1016/S1474-4422(25)00107-3.

New System May Cut Unneeded Stroke Prevention Surgeries

 I still don't understand why you would medically need to stent a carotid artery or do an endarterectomy at all if the Circle of Willis is complete. (Unless the whole point is revenue and profit generation) It would seem to make more sense to just close it up and prevent problems from there.  My right carotid artery was closed for 10 years and I cognitively functioned quite well with no episodes of fainting.

Didn't your competent? doctor tell you of these possible complications of endarterectomy? NO? So, your doctor isn't competent?

Possible problems:

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Carotid Interventions for Women: The Hazards and Benefits

Female Gender Increases Risk of Stroke and Readmission after CEA(Carotid endarterectomy) and CAS(carotid artery stenting)

Ticagrelor Induced Angioedema Following Carotid Artery Stenting

Cognitive Dysfunction and Mortality After Carotid Endarterectomy

Here is why your doctor needs to GUARANTEE NO complications from stenting!

• stenting (22 posts to May 2011)

• carotid stenting (21 posts to May 2016)

• carotid artery stenting (7 posts to November 2021)

New System May Cut Unneeded Stroke Prevention Surgeries

University College London

Researchers at UCL have tested a new scoring system to measure the risk of stroke in patients with narrowed arteries due to atherosclerosis, which could prevent unnecessary surgeries and stents.

Atherosclerosis is a condition where the blood vessels become narrowed and hardened due to the buildup of plaque, including in the carotid arteries, which carry blood from the heart to the brain. Atherosclerosis can lead to serious health problems like strokes and heart attacks.

Atherosclerosis is a very common condition that can affect anyone, particularly those over the age of 65, smokers and people with a high cholesterol, hypertension or family history of heart or circulatory diseases. It is estimated that atherosclerosis affecting the carotid artery causes up to 20% of strokes.

Currently, many patients undergo surgery or stenting to prevent strokes resulting from atherosclerosis. However, these procedures also carry risks of causing strokes and other serious complications at the time of the intervention.

In the new study, published in The Lancet Neurology and in collaboration with colleagues at the Amsterdam University Medical Centre and the University of Basel, researchers found that using the Carotid Artery Risk (CAR) scoring system can offer a safer alternative, by identifying patients who can be effectively treated with a combination of medications and lifestyle changes tailored to their individual risk factors (otherwise known as optimised medical therapy).

The CAR system was developed by researchers at UCL and the University of Oxford.

Senior author, Emeritus Professor Martin Brown (UCL Queen Square Institute of Neurology), said: "While further follow-up and additional trials are needed to confirm these findings, we recommend using the CAR score to identify patients with carotid narrowing who can be managed with optimised medical therapy alone.

"This approach emphasises personal assessment and intensive treatment of vascular risk factors, potentially sparing many patients from the discomfort and risks of carotid surgery or stenting.

"Additionally, this method could lead to substantial cost savings for health services."

The new research paper, which was partly funded by the Stroke Association, evaluated the effectiveness of the CAR score by testing it in a randomised clinical trial involving 428 patients across 30 centres in the UK, Europe and Canada.

All patients involved in the trial were over the age of 18 and had a significant narrowing of their carotid arteries, which was picked up before it had caused symptoms or after it had caused a minor stroke.

Those with symptoms were selected using their CAR score – which takes into account factors such as the percentage of narrowing in the carotid artery and medical history – to determine who had a low to intermediate risk of stroke over the next five years and could be included in the trial. Patients with a high score were not suitable for the trial and were recommended immediate surgery or stenting.

The patients in the trial were then divided into two groups, with one group receiving optimised medical therapy alone, and the other group receiving both optimised medical therapy and additional carotid surgery or stenting.

Optimised medical therapy included a low cholesterol diet, target-adjusted cholesterol-lowering medication, treatment to lower blood pressure, antithrombotic therapy (a treatment that helps prevent blood clots from forming or growing), and regular checks to adjust the medication as necessary.

The patients were monitored through regular visits, telephone calls, and brain scans to detect strokes.

The researchers found that, over the first two years, patients in the trial who were treated with optimised medical therapy alone had very low rates of recurrent strokes and heart attacks. Those who underwent additional surgery or stenting did not experience significant benefits, considering the associated risks of these procedures.

Dr Louise Flanagan, Head of Research at the Stroke Association, said: "Atherosclerosis is a common condition, and a major risk factor for heart disease and stroke. Whilst medical therapy is the first line of treatment, many of those who have medical therapy then need surgery or stenting which can lead to complications including an increased risk of stroke, and other unpleasant side effects.

"The CAR risk score offers the opportunity to take away the downsides of surgery and stenting by using medical therapy alone as well as combining medical therapy with surgery. The Stroke Association is pleased to have funded this trial which indicates that some people with atherosclerosis could see the same benefits from medication and lifestyle changes that previously required surgery.

"The medical therapies used to reduce the risk of stroke from atherosclerosis work by treating risk factors for stroke, including high cholesterol and raised blood pressure, which we are putting at the heart of our recommendations for the Government's 10 Year Health Plan .

"Whilst we welcome the results of this study, we note the need for more research to confirm or refute these findings, so we look forward to further developments."

The research was funded in the UK by the National Institute for Health and Care Research (NIHR), the Stroke Association and the Leeds Neurology Foundation, and in Europe by the Swiss National Science Foundation and the Dutch Organisation for Knowledge and Innovation in Health, Healthcare and Well-Being.

/Public Release. This material from the originating organization/author(s) might be of the point-in-time nature, and edited for clarity, style and length. Mirage.News does not take institutional positions or sides, and all views, positions, and conclusions expressed herein are solely those of the author(s).View in full here.