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Controversies in Neurology
May 2003

How Should We Design Studies for Stroke Prevention?

Author Affiliations

From the Department of Neurology, University of Pittsburgh, Pittsburgh, Pa.

 

STEVEN T.DEKOSKYMD

Arch Neurol. 2003;60(5):778-779. doi:10.1001/archneur.60.5.778

IN THIS month's "Controversies in Neurology" section, Dr Chaturvedi proposes that the NASCET1 and ACAS2 should be repeated. Actually, Dr Chaturvedi's well-reasoned argument is not so much for a replication of those studies but a rationale for the next NASCET and ACAS studies. He believes that they are outdated, a circumstance that is frequently the fate of such large, long, and difficult-to-perform multicenter trials. However, Dr Chaturvedi's call is really for 2 studies, 1 specifically targeted at the group with intermediate carotid stenosis (50%-75%), whose outcome was not markedly different with surgery vs best medical therapy. His argument is that with new medications, best medical therapy would show significant improvement compared with surgery. These 2 new studies would examine best medical therapy alone vs best medical therapy plus carotid endarterectomy in asymptomatic and symptomatic patients who have carotid stenosis of 50% to 75%.

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