Stroke-preventing surgery works, but it's not without risk

When Benjamin Franklin famously wrote "An ounce of prevention is worth a pound of cure," he could well have been talking about stroke prevention. Recovering from a stroke can be a long and complex process, with 15 percent to 30 percent of people left with some disability even after extensive treatment. In comparison, studies show that relatively small preventive steps—such as exercising regularly, eating a healthy diet low in saturated fat, and not smoking—can make a real difference in lowering your risk of having a stroke in the first place.

However, the prevention-cure equation gets a bit more complicated when considering a stroke-preventing surgery called carotid endarterectomy. It's used to help people who are at higher risk of a stroke due to fatty deposits inside the arteries in their neck. A surgeon makes a cut in the patient's neck, opens up the artery, clears out the fatty deposits, and stitches the artery closed again. Clearing the narrowed artery stops a blockage or blood clot from forming and causing a stroke.

But unlike simple preventive steps, such as changing your diet, a carotid endarterectomy has serious risks, as there's a chance of dying or having a stroke soon after the surgery. So, do the benefits of this preventive surgery usually outweigh these risks?

To find out, a new study has looked at 3,120 people who had narrowed arteries but no symptoms. Half the people in the study had surgery right away, and the other half postponed surgery with the option of changing their mind later.

Not counting strokes or deaths that happened soon after surgery, 10.8 percent of surgery patients had a stroke in the next 10 years. This compared with 16.9 percent of people who avoided surgery or delayed it until later. About 26 percent of the people who didn't have surgery immediately went on to have the operation at some point over the 10 years.

But surgery was risky, with 3 percent of patients dying or having a stroke in the 30 days after treatment. If we include the side effects of surgery in the figures, 13.4 percent of people who had surgery immediately had a stroke during the 10-year study, compared with 17.9 percent of people who went without surgery or delayed it. So, surgery still offered an overall benefit, although this was tempered by the risks.

And, for some people, these risks may not be worth taking. For example, an older person will have a higher chance of dying from other causes in the years after surgery. This means that they will face all the short-term risks of surgery but perhaps not live long enough to get the benefits. The people most likely to benefit from surgery are under age 75 and in good health apart from a narrowed neck artery, the researchers say.

What you need to know. Surgery to clear clogged arteries in the neck can prevent a stroke, but this benefit must be balanced against the short-term risks, which include a stroke or death.

If you think you might be at risk of a stroke, talk to your doctor. There are many treatments that can help, from lifestyle changes to medications. If surgery is an option, make sure you get a clear understanding from your surgeon about whether the benefits outweigh the risks for you. Ben Franklin would no doubt approve of such prudent steps (although, incidentally, his "ounce of prevention" adage actually related to fire safety!).

—Sophie Ramsey, patient editor, BMJ Group

ConsumerReportsHealth.org has partnered with The BMJ Group to monitor the latest medical research and assess the evidence to help you decide which news you should use

For more heart-health news, sign up for our free monthly Heart e-mail newsletter and our mobile alerts.