The chart shows the difference between surgical therapy and medical therapy over time for patients who did not have a neurological event, such as stroke or death. Figure 41 shows data for any ipsilateral stroke. This is where the patient has any kind of stroke. Another observation that is absolutely fascinating as we look at this data is that surgery is a cure for carotid disease. This is baffling to a number of people.
Surgery is still better, but the lines are definitely getting closer.
So the characterization of the degree of stenosis is an absolutely critical issue for separating patients into a group that will do great versus a group that will do okay. The degree of benefit is proportional to the degree of angiographically measured stenosis. Hence, it has been suggested that a combination of risk profile and degree of stenosis may be co-determinants in deciding between medical and surgical management in cases with less severe carotid stenoses. An interesting issue is the effect of aspirin. It has an amazing protective effect.