A European study introduces a new tool to understand whether to focus on surgery or pharmacological treatment
After 65 years, unfortunately, it is not easy to find arteries completely unscathed by damage of the atherosclerosis. When this process affects the carotids, that is to say the vases that bring blood to the brain, the risk of stroke increases significantly. The estimates indicate that plates in these arteries can contribute to about a fifth of the ischemic cerebral events, but deciding how to intervene is not always easy: in some cases it is better to operate, in others a pharmacological treatment is sufficient. How to distinguish between the different clinical scenarios? At the opinion of the experts, a new objective index is accompanied, The CAR scorewhich allows to assess the individual risk of stroke and direct the therapeutic choice.
Read also: what is atherosclerosis: symptoms, risks, prevention and advice
Stroke risk and CAR score
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The Car (Carotid Artery Risk) score was developed by an international team of researchers from the University College London, of the Amesterdam University Medical Center, the University of Basel and the University of Oxford. The goal is Identify patients with carotid stenosis which, despite having a significant narrowing of the vessels, can be followed with one optimized drug therapyavoiding invasive interventions such as the stent system. In other words: surgery yes, but only where strictly necessary. The score takes into account various clinical and imaging parameters, and allows you to stratify the risk of stroke in the following five years. “We recommend using the CAR score to identify patients with carotid narrowing that can be managed with only optimized medical therapy,” says Martin Brown, main author of the study published on Lancet Neurology. “This approach emphasizes the personalized assessment and intensive treatment of vascular risk factors, potentially saving many patients the discomfort and risks of a carotid surgery or a stent system”.
CAR score, clinical study
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To test the reliability of the score system, the researchers conducted one Randomized clinical study on 428 patientsdistributed in 30 centers between the United Kingdom, Europe and Canada. All participants had a significant narrowing of the carotid arteries, diagnosed before the undetected of the symptoms or after non -invalidating stroke. Patients with a high -high score, therefore at greater risk, were excluded from the study and immediately directed towards the intervention. The others, with low or intermediate score, were divided into two groups: one received only optimized medical therapy, the other also associated the latter also a surgery or a stent system.
Over the two years of observation, patients treated exclusively with optimized medical therapy reported Very low rates of stroke and heart attack. In selected subjects, the addition of the intervention did not bring significant benefits in terms of prevention, in the face of all the procedural risks typical of invasive techniques. Optimized medical therapy included a low cholesterol diet, ipocolesterolemizing drugs, antihypertensive treatment, antitrombotic therapy and regular controls.
Stroke risk and personalized therapy
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In the judgment of the authors of the study, the CAR score represents a useful tool for customize the treatment of patients with carotid stenosis. There are asymptomatic stenosis, often identified with screening exams, and symptomatic stenosis, associated with neurological events such as loss of strength, visual or language disorders and seconds involve a greater risk of stroke. Drug therapy, in these cases, can be very effective, especially if i LDL cholesterol values are maintained below 70 mg/dl In unprecedented patients stroke. “The risk of intervention in recent years has been very reduced”, concludes Del Sette, “but it is still necessary to make an accurate selection of the patients to be launched on this path, which in any case adds to drug therapy as well as any modifications of the lifestyle”.
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