Arterial Disease Prevention
- Stroke prevention; arterial disease prevention; best practice; ‘evidence-true’ guidelines; carotid artery disease; carotid stenosis; carotid endarterectomy; carotid stenting
This group has grown from the study of carotid stenosis and stroke prevention. Carotid stenosis is atherosclerotic narrowing of the main brain artery. Advanced carotid stenosis (≥50%) occurs in about 10% of people by their eighth decade and causes about 10% of strokes (Abbott et al 2007). The good news discovery from our previous work is that stroke prevention has become more effective, less invasive and cheaper.
Over the last 3-4 decades, stroke rates in individuals with advanced, symptom-free carotid stenosis have dropped ≥65% with medical intervention alone (lifestyle coaching and medication, Abbott, 2009; Abbott et al, 2017). Average annual same-sided stroke rates approximate 0.8% per year, lower than with surgery or stenting in past trials. Medical intervention alone is now best management for symptom-free carotid stenosis. Plus, there are implications for better prevention of all arterial disease complications in all people.
However, existing guidelines worldwide do not reflect this dramatic improvement in medical intervention effectiveness. Further, in many ways, existing guidelines encourage overuse of carotid artery surgery and stenting (Abbott et al 2015). In addition, knowledge regarding medical intervention has evolved over decades and across many medical specialties causing confusion. We aim to improve global standards of preventing stroke and other arterial disease complications by:
- Producing the world’s first ‘evidence-true guideline’ with respect to management of carotid artery disease in collaboration with the International Union of Angiology.
- Characterising the nature of current optimal medical intervention (risk factor identification and amelioration using lifestyle coaching and medication).
- Using novel, effective translational methods to engage the world to use the best methods of preventing stroke and other arterial disease complications.
- Studying the impact of best medical intervention alone for persons with carotid stenosis during the COVID-19 Era (CASCOM Study).
If you like dispelling dogma and improving global health standards, this is a great opportunity. Central is first getting the facts straight (through critical comparative audits of guidelines and systematic reviews of original research). Integral are exciting collaborative opportunities through the Faculty Advocating Collaborative and Thoughtful Carotid Artery Treatments (FACTCATS, see FACTCATS.org). This is a multi-national, multi-specialty, multi-disciplinary network of clinicians and scientists of all career stages. With over 320 members, we debate evidence and collaborate to improve standards of preventing stroke and other arterial disease complications via joint email.
For information about current short- or long-term projects please contact A/Prof Anne Abbott.
Current Project Funding
A/Prof Anne Abbott currently holds an NHMRC TRIP Fellowship.
- Medical (nonsurgical) intervention alone is now best for prevention of stroke associated with asymptomatic severe carotid stenosis: Results of a systematic review and analysis. Abbott, Stroke, 2009
- A Systematic Review of Guidelines for the Management of Asymptomatic and Symptomatic Carotid Stenosis. Abbott et al, Stroke, 2015.
- Why Calls for More Routine Carotid Stenting Are Currently Inappropriate: An International, Multispecialty, Expert Review and Position Statement. Abbott and 50 others, Stroke, 2013
- Improving Outcomes in Patients With Carotid Stenosis; Call for Better Research Opportunities and Standards. Abbott and Nicolaides, Stroke, 2015
- Misconceptions Regarding the Adequacy of Best Medical Intervention Alone for Asymptomatic Carotid Stenosis. Abbott et al, Journal of Vascular Surgery, 2019
- Optimizing the Definitions of Stroke, Transient Ischemic Attack, and Infarction for Research and Application in Clinical Practice. Abbott et al, Frontiers in Neurology, 2017
See more about Anne and her work at her Monash researcher profile.