Patients have useless surgery, stroke study warns

Surgery for one of the most common causes of stroke has “little, if any” benefit and is a “waste of vital health resources”, Melbourne researchers have found.

Monash University Associate Professor Anne Abbott says there is ‘no current evidence of procedural benefits’ for surgery for stroke patients. Picture: iStock

Surgery for one of the most common causes of stroke has “little, if any” benefit for patients, a shocking Monash University study has found.

The research suggests lifestyle changes and medication are far more effective treatments for patients with advanced carotid artery stenosis (CAS), a build-up of plaque in a major artery.

The study, published in the Frontiers in Neurology journal, analysed more than forty decades of data and contradicts guidelines for advanced CAS, which list surgery and stents, in addition to lifestyle changes, as a treatment option.

Monash University Associate Professor Anne Abbott said her study shows patients were undergoing unnecessary surgery as a result of a misconception about the benefits of surgery.

The study found patients are undergoing unnecessary surgery. Picture: iStock

“(This causes) large-scale harm and premature death, while wasting vital health resources,” she said.

“Carotid artery procedures are still very commonly done in Australia and overseas and they continue to cause significant complications, including stroke, death and heart attack, and they are costly.

“We have been using them inappropriately and overusing them.”

She said while decades-old trials had shown benefits for a small group of patients, the effectiveness of non-invasive treatments – such as medication and lifestyle advice – had significantly improved since then.

“There’s no current evidence of procedural benefits,” she said.

“We really need to address this because these procedures carry significant risk of harm, patient harm.”

She called for an overhaul of current guidelines, and said clinical trials on the small groups of patients initially thought to benefit should be repeated.

“(The current thinking) has to be challenged to change it,” she said.

“There needs to be more accountability and incentives put in place to deliver best practice.”

She said the good news from her study is that advanced CAS patients don’t need to undergo invasive procedures to significantly reduce their stroke risk.

“It’s now clear that the individual has the most power to prevent their own stroke,” she said.

“Things like trying to be at a healthy weight, trying to exercise regularly, not smoking, not drinking excessive alcohol and attending to things like being screened.

“If people try this, they can reduce their stroke risk by at least 65 per cent.”

She said anyone feeling overwhelmed by the thought of changing their lifestyle should start small, as “every little bit helps”.

“Just going for a walk around the block every day, for example, is a start,” she said.

“Start bit by bit and try and recognise a negative attitude in yourself, because that’s probably the biggest barrier.

“Half the battle is empowering yourself, motivating yourself and acknowledging to yourself that actually, you can do this stuff.

“Even just losing a few kilograms, for example, can make a big difference to your risk of stroke.”