Most patients with carotid stenosis of 50% or more at low to medium risk of further stroke could be spared from revascularisation, a groundbreaking study has found.

The randomised trial across 30 stroke centres in Canada and Europe found no evidence that adding carotid endarterectomy or stenting to optimised medical therapy improved outcomes in the two years following a stroke.

If confirmed, the findings could rewrite international guidelines, emphasising a new approach based on patient risk assessment, the researchers said.

“This approach emphasises personal assessment and intensive treatment of vascular risk factors, potentially sparing many patients from the discomfort and risks of carotid surgery or stenting,” said the study’s senior author, Emeritus Professor Martin Brown from University College London.