Imaging Detects Asymptomatic People at Risk for Stroke

Cerebrovascular reserve (CVR) testing can help identify asymptomatic patients with carotid artery stenosis who are most likely to benefit from revascularization, according to an article published online in the journal Radiology.

Researchers from Weill Cornell Medical College in New York, NY, sought to project and compare the lifetime health benefits, healthcare costs and incremental cost-effectiveness of stroke prevention strategies among patients who had carotid artery stenosis but were also asymptomatic.

For the study, the researchers used transcranial Doppler (TCD) sonography and 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 worsened.

“A decision analytic model was developed to project lifetime quality-adjusted life years (QALYs) and costs for asymptomatic patients with carotid stenosis with 70 percent to 89 percent carotid luminal narrowing at presentation,” the authors wrote.

The results showed that the medical therapy-based strategy was associated with the lowest lifetime costs and the fewest revascularizations. However, this strategy also resulted in the lowest life expectancy and lifetime quality-adjusted years.

“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,” co-author Ankur Pandya, PhD, assistant professor of healthcare policy and research and public health in radiology at Weill Cornell Medical College, said in a release. “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.”