A new modeling study published online in the journal Radiology says that imaging can be a cost-effective way to identify people at risk for stroke.
The study looked at people with asymptomatic carotid artery stenosis, a narrowing of the major blood vessels supplying blood to the head due to atherosclerosis, or plaque buildup. Carotid artery stenosis is the primary cause of up to 20 percent of ischemic strokes, which result from an obstruction within a blood vessel and make up 85 percent of all strokes. Stroke victims often undergo revascularization procedures like carotid endarterectomy, or surgical removal of the plaque, to restore blood flow, but use of the procedures in asymptomatic patients is more controversial, according to Ankur Pandya, Ph.D., assistant professor of healthcare policy and research and public health in radiology at Weill Cornell Medical College in New York City.
"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," Dr. Pandya said.
Dr. Pandya and colleagues recently assessed the impact of cerebrovascular reserve (CVR) testing, a measure of blood flow reserve to the brain, on asymptomatic people with significant carotid artery stenosis. While different imaging modalities can be used in CVR testing, the researchers used transcranial Doppler (TCD) sonography, an inexpensive, widely available option that does not expose patients to ionizing radiation. They constructed a mathematical model that allowed them 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 got worse.