Dispelling the furphies in stroke prevention treatments

Associate Professor Anne Abbott has published a provocative, concise analysis outlining important misunderstandings about how to best prevent stroke in Nature Reviews Cardiology.

A/Prof Abbott has an adjunct appointment in the Central Clinical School's Department of Neuroscience. She says misconceptions, or ‘furphies’, remain widespread, and their continued acceptance by medical practitioners is damaging people’s health and wasting billions of healthcare dollars around the world every year.

Her review outlines two broad classes of furphy. They relate to carotid artery procedures and drugs used in the name of reducing the risk of stroke and other arterial disease complications. A/Prof Anne Abbott says there is well established, current evidence that medical intervention alone (that is, lifestyle coaching and medication) will improve patient outcomes. However, information about current best practice with respect to diagnosing and managing arterial disease risk factors has evolved across many specialties over many decades causing confusion and uncertainty about how to best use medical intervention.

At the same time, there has only ever been very limited evidence for overall benefit from carotid artery surgery (endarterectomy) in reducing stroke risk. This applied to highly selected patient subgroups with severe arterial disease (narrowing) of the carotid artery (main brain artery). Despite that, guidelines recommend carotid surgery and now stenting - which is more dangerous than surgery - well beyond patients' subgroups ever shown to benefit.

A/Prof Abbott said, “All randomised trial evidence of a surgical benefit is very outdated due to at least a 65% improvement in the stroke prevention effectiveness of medical intervention since the randomised trials were performed. Therefore, there is no current evidence of procedural benefit for any subgroup of patients with carotid stenosis.” However, she said, both surgery and stenting are still widely performed in many countries, including Australia, including for patient subgroups for whom a procedural benefit has never been established.

A/Prof Abbott has been battling furphies for years. In 2020 she was awarded the John Maddox Prize for early career researchers from all fields of science across the world. This award, administered by Sense about Science in partnership with Nature, is for showing great courage and integrity in standing up for scientific reasoning despite opposition and hostility. Senior career winners in 2020 were Drs Anthony Fauci and Salim Abdool Karim.

A/Prof Abbott’s is calling for all medical practitioners involved in managing people at risk from stroke to better understand the evidence base and, thereby, use more effective and safer treatments.

See more:

Abbott, A. Carotid stenosis management: time to address the misconceptions (‘furphies’). Nature Reviews Cardiology. https://www.nature.com/articles/s41569-021-00543-2