According to a new study published in the journal Radiology, imaging could be an effective method to identify patients at risk of stroke who could benefit from aggressive intervention.
Carotid artery stenosis, a narrowing of the blood vessels in the head due to atherosclerosis, or plaque buildup, is the primary cause of 20% of all ischemic strokes. Ischemic strokes result from an obstruction within a blood vessel and make up 85% of all strokes. Procedures like carotid endarterectomy, or surgical removal of the plaque, can restore blood flow, but performing these procedures on asymptomatic patients remains controversial.
“There are complications and costs associated with these revascularization procedures, and they are often done without knowing if the risks and costs are worth the benefits,” said Ankur Pandya, PhD, assistant professor of healthcare policy and research and public health in radiology at Weill Cornell Medical College in New York City.
Pandya and his team evaluated patients with asymptomatic carotid artery stenosis by performing cerebrovascular reserve (CVR) testing, a measure of blood flow reserve to the brain. While several imaging options are available, the team used transcranial Doppler (TCD) sonography, a widely available, cost-effective method that does not expose patients to ionizing radiation. They then constructed a mathematical model to make hypothetical comparisons among three different approaches: CVR testing, immediate revascularization with carotid endarterectomy, and medical therapy-based management with subsequent revascularization only for patients whose stenosis worsened.
Pandya found that the CVR approach offered the best balance of benefits and costs, with about half of patients ultimately receiving revascularization. While most cost-effective, the medical therapy-based strategy resulted in the lowest life expectancy and lifetime quality-adjusted years, which account for both the length and quality of life experienced by patients. Immediate revascularization had the highest costs and offered only incremental health benefits compared to the CVR-based approach.
“The study results show that imaging can be a cost-effective tool to stratify patients by risk of stroke and help sort patients into invasive, expensive interventions and less invasive options,” Pandya said.
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